The Financial Burden of Reexcising Incompletely Excised Soft Tissue Sarcomas: A Cost Analysis

Alamanda, Vignesh K.; Delisca, Gadini O.; Mathis, Shannon L.; Archer, Kristin R.; Ehrenfeld, Jesse M.; Miller, Mark; Homlar, Kelly C.; Halpern, Jennifer L.; Schwartz, Herbert S.; Holt, Ginger E.

doi:10.1245/s10434-013-2995-5

Cited by 41 publications

(29 citation statements)

References 23 publications

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“…According to Alamanda et al, professional costs (i.e., charges billed by surgeons) significantly increased in re-resections compared with primary surgeries 18. Even after adjustment for influential parameters, such as tumour grade, site, size, and the fitness of patients before surgery, re-excisions were associated with a 33% increase in professional charges 18…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

et al. 2017

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BackgroundUnplanned excisions (UE) of soft tissue sarcomas (STS) carry a high risk for local recurrence (LR) due to marginal/intralesional resections. However, there are reports about improved prognosis for UE patients who have re-resection compared with patients who undergo planned surgery. The present multicentre study was designed to define characteristics of UE patients and to investigate the impact of UE on subsequent therapy and patient outcomes.MethodsA total of 728 STS patients (376 males, 352 females; mean age: 58 years) who underwent definite surgery at one of three tumour centres were retrospectively included. Time-to-event analyses were calculated with log-rank and Gray’s tests, excluding patients with primary metastasis (n = 59). A propensity-score (PS) of being in the UE group was estimated, based on differences at baseline between the UE group and non-UE group. An inverse-probability-of-UE weight (IPUEW) was generated and time-to-event analyses calculated after IPUEW weighting.ResultsBefore referral, 38.6% of patients (n = 281) had undergone UE. Unplanned excision patients were younger (p = 0.036), rather male (p = 0.05), and had smaller (p < 0.005), superficially located tumours (p < 0.005). Plastic reconstructions (p < 0.005) and adjuvant radiotherapy (p = 0.041) more often were needed at re-resection. In univariable analysis, re-resected patients had improved overall survival (OS; p = 0.027) and lower risk of distant metastasis (DM; p = 0.002) than primarily resected patients, whereas risk of LR was similar (p = 0.359). After weighting for the IPUEW, however, differences in terms of OS (p = 0.459) and risk of DM (p = 0.405) disappeared.ConclusionsThe present study does not support prior findings of improved outcome for UE patients. Unplanned excisions have a major impact on subsequent therapy, yet they do not seem to affect negatively the long-term oncology outcome.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

et al. 2017

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“…Factors that may influence charge accrual during initial treatment include: length of hospitalization, number of procedures, and type of procedures [16, 17, 18, 19]. For example, Petruzzelli et al .…”

Section: Discussionmentioning

confidence: 99%

“…These complications may precipitate additional interventions that can increase costs after initial treatment [16, 17, 18, 19]. Recent evidence has shown that utilizing staged reconstruction (SR) brachytherapy can minimize toxicity when compared to traditional IR [20].…”

Section: Purposementioning

confidence: 99%

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Naghavi

Gonzalez²,

Scott

et al. 2017

jcb

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PurposeAdjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methodsA retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.ResultsMedian follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).ConclusionsIn recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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“…Factors that may influence charge accrual during initial treatment include: length of hospitalization, number of procedures, and type of procedures [16,17,18,19]. For example, Petruzzelli et al noted a cost difference in regards to reconstructive modality [21].…”

Section: Discussionmentioning

confidence: 99%

“…These complications may precipitate additional interventions that can increase costs after initial treatment [16,17,18,19]. Recent evidence has shown that utilizing staged reconstruction (SR) brachytherapy can minimize toxicity when compared to traditional IR [20].…”

Section: Purposementioning

confidence: 99%

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

Naghavi

Gonzalez

Scott

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Adjuvant brachytherapy (AB) with immediate (IR) and staged reconstruction (SR) are distinct treatment modalities available for patients with recurrent soft tissue sarcoma (STS). Although SR may offer local control and toxicity benefit, it requires additional upfront procedures, and there is no evidence that it improves overall survival. With the importance of value-based care, our goal is to identify which technique is more cost effective.Material and methods: A retrospective review of 22 patients with recurrent extremity STS treated with resection followed by AB alone. Hospital charges were used to compare the cost between SR and IR at the time of initial treatment, at 6-month intervals following surgery, and cumulative cost comparisons at 18 months.Results: Median follow-up was 31 months. Staged reconstruction (n = 12) was associated with an 18-month local control benefit (85% vs. 42%, p = 0.034), compared to IR (n = 10). Staged reconstruction had a longer hospital stay during initial treatment (10 vs. 3 days, p = 0.002), but at 18 months, the total hospital stay was no longer different (11 vs. 11 days). Initially, there was no difference in the cost of SR and IR. With longer follow-up, cost eventually favored SR, which was attributed primarily to the costs associated with local failure (LF). On multivariate analysis, cost of initial treatment was associated with length of hospital stay (~$4.5K per hospital day, p < 0.001), and at 18 months, the cumulative cost was ~175K lower with SR (p = 0.005) and $58K higher with LF (p = 0.02).Conclusions: In recurrent STS, SR has a longer initial hospital stay when compared to IR. At 18 months, SR had lower rates of LF, translating to lower total costs for the patient. SR is the more cost-effective brachytherapy approach in the treatment of STS, and should be considered as healthcare transitions into value-based medicine.

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The Financial Burden of Reexcising Incompletely Excised Soft Tissue Sarcomas: A Cost Analysis

Abstract: Reexcision of an incompletely excised sarcoma results in significantly higher professional charges when compared to a single, planned complete excision. Additionally, when the cost of the primary unplanned surgery is considered, the financial burden nearly doubles.

Cited by 41 publications

References 23 publications

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

The Prognostic Impact of Unplanned Excisions in a Cohort of 728 Soft Tissue Sarcoma Patients: A Multicentre Study

Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Staged Reconstruction Brachytherapy Has Lower Overall Cost in Recurrent Soft Tissue Sarcoma

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