Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy

Boukovalas, Stefanos; Li, Jun; Asaad, Malke; Schaverien, Mark V.; Akay, Catherine Liebig; Garvey, Patrick B.; Hwang, Rosa F.

doi:10.1016/j.jamcollsurg.2021.05.008

Cited by 10 publications

(3 citation statements)

References 54 publications

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“… 38 The choice of breast-conserving therapy or mastectomy was not associated with financial toxicity in early-stage cancer. 39 An analysis of US national sample demonstrated that over 9 out of 10 uninsured and 1 out of 10 privately insured individuals were at risk of financial toxicity after surgery. 40 In the current study, surgical treatment was not associated with worse financial toxicity than chemotherapy, even in the subgroup analysis of cancer types and clinical stages.…”

Section: Discussionmentioning

confidence: 99%

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

Yu¹,

Li²,

Zuo³

et al. 2022

Asia-Pacific Journal of Oncology Nursing

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Section: Discussionmentioning

confidence: 99%

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

Yu¹,

Li²,

Zuo³

et al. 2022

Asia-Pacific Journal of Oncology Nursing

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“…The long-term effects of price transparency in plastic surgery have yet to be determined. Although plastic surgery is unique among surgical specialties in its relatively high degree of preference sensitivity, 39 it remains to be seen whether price transparency initiatives alone will have the desired effect on lowering health care spending given the complicated nature of microsurgical reconstruction and effects of both brand and the physician-patient relationship on demand-side decision-making. 40 Additional measures beyond price transparency may be needed to reduce waste within the current pricing structure of free flap operations.…”

Section: Discussionmentioning

confidence: 99%

Free Flap Reconstruction in the Era of Commercial Price Transparency – What are We Paying For?

Rochlin,

Rizk,

Mehrara

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Commercial rates for free flap reconstruction were not known publicly prior to the 2021 Hospital Price Transparency Final Rule. The purpose of this study was to examine commercial facility payments to characterize nationwide variation for microsurgical operations and identify opportunities to improve market effectiveness. Methods: A cross-sectional study was performed using 2022 commercial insurance pricing merged with hospital performance data. Facility payment rates were extracted for nine CPT codes for free flap operations. Price variation was quantified via across-hospital ratios (AHRs) and within-hospital ratios (WHRs). Mixed effects linear models evaluated commercial rates relative to value, outcomes, and equity performance metrics, in addition to facility-level factors that included healthcare market concentration. Results: 20,528 commercial rates across 675 hospitals were compiled. AHRs ranged from 5.85–7.95, while WHRs ranged from 1.00–1.71. Compared to the lowest scoring hospitals (grade D), hospitals with an outcome grade of A and equity grades of B or C were associated with higher commercial rates (p<0.04); there were no significant differences in rate based on value. Higher commercial rates were also associated with nonprofit status and more concentrated markets (p<0.006). Lower commercial rates were correlated with safety-net and teaching hospitals (p<0.001). Conclusion: Commercial rates for free flaps varied substantially both across and within hospitals. Associations of higher commercial rates with less competitive markets, and the lack of consistent association with value and equity, identify pricing failures. Additional work is needed to improve market efficiency for free flap operations.

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“…Given the significant cost associated with the use of ADM, the increased cost burden on patients undergoing breast reconstruction, and the similarity in surgical outcomes, it is important for surgeons to consider cost differences among ADMs when choosing the type of ADM for IBR. 25,[33][34][35][36] It is evident that the difference in product price could significantly affect the overall cost of the procedure. 25 Other studies have shown that AlloDerm has a higher cost than SurgiMend and Dermacell.…”

Section: Ementioning

confidence: 99%

No Differences in Surgical and Patient-reported Outcomes Between Alloderm, Surgimend, and Dermacell for Prepectoral Implant-based Breast Reconstruction

Asaad

Morris

Selber

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Prepectoral implant–based breast reconstruction (IBR) has become the standard of care for many reconstructive surgeons and is often supplemented with coverage using acellular dermal matrix (ADM). However, more clinical data examining the use of ADM in breast reconstruction are needed. The current study compares complications and patient-reported outcomes (PROs) among three different types of ADM used in IBR. Methods: The authors performed a retrospective review of consecutive patients who underwent immediate prepectoral IBR from January of 2018 through December of 2019. Surgical outcomes and PROs (using the BREAST-Q) were compared among the AlloDerm, SurgiMend, and Dermacell ADMs. Results: Overall, 557 breasts (383 patients) were included (78.6% AlloDerm, 14% SurgiMend, 7.4% Dermacell). Patients in the Dermacell group were older (P = 0.001) and more likely to have diabetes (P = 0.001) compared with AlloDerm and SurgiMend patients. Other patient characteristics were similar among the three groups. The overall complication rate was equivalent among the three ADM groups (AlloDerm 27% vs SurgiMend 33% vs Dermacell 39%; P = 0.209). Multivariable frailty models demonstrated that the type of ADM was not significantly associated with overall complications, infection, major complications, or device explantation. BREAST-Q satisfaction with breasts, psychosocial well-being, and sexual well-being were also similar among the three ADM groups (P = 0.109, P = 0.439, P = 0.152, respectively). Conclusions: Three of the most commonly used ADMs in the United States have similar surgical outcomes and PROs when used for prepectoral IBR. No significant differences in infection, overall complications, or device removal rates were identified among AlloDerm, SurgiMend, and Dermacell. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Relationship Between Financial Toxicity and Surgical Treatment for Early-Stage Breast Cancer: A Propensity Score-Matched Comparison of Breast-Conserving Therapy and Mastectomy

Cited by 10 publications

References 54 publications

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis

Free Flap Reconstruction in the Era of Commercial Price Transparency – What are We Paying For?

No Differences in Surgical and Patient-reported Outcomes Between Alloderm, Surgimend, and Dermacell for Prepectoral Implant-based Breast Reconstruction

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