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Stereotactic core biopsy reduces the reexcision rate and the cost of mammographically detected cancer |
Lind D S, Minter R, Steinbach B, Abbitt P, Lanier L, Haigh L, Vauthey J N, Russin M, Hackett R, Copeland E M |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Stereotactic core biopsy (SCB) in the diagnosis and management of patients with non-palpable breast cancer who underwent breast-conserving surgery.
Economic study type Cost-effectiveness analysis.
Study population Patients with mammographically detected breast cancer undergoing breast conserving surgery.
Setting Hospital. The economic study was carried out in Florida, USA.
Dates to which data relate Effectiveness data were collected during the period from January 1995 to June 1997. The date for the resource use data was not reported. The fiscal year was not explicitly specified.
Source of effectiveness data The evidence for final outcomes was derived from a single study.
Link between effectiveness and cost data The costing was undertaken retrospectively on the same patient sample as that used in the effectiveness study.
Study sample Power calculations were not used to determine the sample size. The study sample consisted of 117 patients with non-palpable breast cancer who underwent breast-conserving surgery at the study hospital. Patients who subsequently underwent mastectomy after SCB or NLB were excluded from the analysis. The NLB group comprised 69 patients versus 48 patients in the SCB group.
Study design This was a retrospective cohort study, carried out in a single centre. The decision to perform a biopsy and the method of management were a collaborative decision involving the surgeon, radiologist and patient. The duration of follow-up was until reexcision. No loss to follow-up was reported.
Analysis of effectiveness The principle (intention to treat or treatment completers) used in the analysis of the clinical study was not explicitly stated. The time interval from detection to diagnosis and breast-conserving surgery, volume of breast tissue excised, margin status and reexcision were the primary outcome measures.
Effectiveness results The time from detection to diagnosis was 1.7 (+/- 0.5) days for those patients who underwent SCB and 6.8 (+/- 1.3) days for those patients who underwent NLB, (p<0.01). The time from mammography to breast-conserving surgery was 8.1 (+/- 2.1) days for the SCB patients and 16.9 (+/- 2.3) days for the NLB patients, (p<0.01). Patients who underwent SCB had a larger volume of breast tissue excised than patients who underwent NLB: 117.9 (+/- 5.6) cm^2 versus 75.2 (+/- 2.9) cm^2, (p<0.01). Only 3 patients (6%) who underwent SCB had positive margins, while 38 patients (55%) who underwent NLB had positive margins, (p<0.01). Only 1 patient with positive margins who underwent SCB was reexcised, while 34 of 38 patients with positive margins following NLB were reexcised.
Clinical conclusions SCB shortens the time from detection at mammography to diagnosis and breast-conserving therapy, permits appropriate discussion of treatment alternatives, and reduces the positive margin rate and reexcision rate.
Measure of benefits used in the economic analysis No summary benefit measure was identified in the economic analysis, and only separate clinical outcomes were reported.
Direct costs Costs were not discounted due to the short time frame of the study. Quantities of resource use were not reported separately from the costs. The cost items were broken down. Health service costs were included in the analysis. The estimate of quantities was based on actual data. The perspective adopted in the cost analysis was not explicitly specified. Cost data were obtained from the hospital's patient database. Charges included professional fees (mammographer, surgeon, anesthesiologist and pathologist), time spent in the operating room and recovery room, and other hospital charges. The date to which the price data referred was not explicitly specified.
Statistical analysis of costs Fisher's exact test was used to compare the study groups in terms of charges and costs.
Estimated benefits used in the economic analysis Cost results Total charges per patient in the SCB group was $11,700 (+/- $554) versus $15,654 (+/-$706) in the NLB group, (p<0.0001). The corresponding figures for the total costs per patient were $3,537 (+/- $167) versus $4,853 (+/- $198), respectively, (p<0.0001).
Synthesis of costs and benefits A synthesis of costs and benefits was not performed since the use of SCB was regarded as the dominant strategy.
Authors' conclusions The use of SCB in the diagnosis and management of non-palpable breast cancer shortens the time from detection at mammography to diagnosis and breast-conserving therapy, permits appropriate discussion of treatment alternatives, reduces the positive margin rate and reexcision rate, and may represent a significant cost savings.
CRD COMMENTARY - Selection of comparators reason for the choice of comparator is clear.
Validity of estimate of measure of benefit the authors acknowledged, the internal validity of the effectiveness results may be adversely affected by the retrospective nature of the study. Given the lack of a summary benefit measure, the study should be regarded as a cost-consequences analysis.
Validity of estimate of costs ource quantities were not reported separately from prices and adequate details of the methods of cost estimation were not given. The study lacked a prospective cost analysis.
Other issues en the uncertainties in the data the authors' conclusions may not be fully justified. The issue of generalisability to other settings or countries was not systematically addressed.
Bibliographic details Lind D S, Minter R, Steinbach B, Abbitt P, Lanier L, Haigh L, Vauthey J N, Russin M, Hackett R, Copeland E M. Stereotactic core biopsy reduces the reexcision rate and the cost of mammographically detected cancer. Journal of Surgical Research 1998; 78(1): 23-26 Indexing Status Subject indexing assigned by NLM MeSH Biopsy, Needle /economics; Breast Neoplasms /diagnosis /pathology /surgery; Cost Savings; Female; Health Care Costs; Humans; Mammography /economics; Reoperation /economics; Stereotaxic Techniques AccessionNumber 21998001401 Date bibliographic record published 31/01/2000 Date abstract record published 31/01/2000 |
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