Cost of Contralateral Prophylactic Mastectomy (CPM) Versus Surveillance

• There is robust literature to support the use of CPM as a cost-effective strategy:
  • In patients with hereditary breast cancer syndromes
• Anderson et al. demonstrated that the most cost-effective strategy:
  • With and without quality adjustment:
    • For women with BRCA1 or BRCA2 mutations was:
      • Prophylactic bilateral salpingo-oophorectomy with bilateral mastectomy
• Simulation models analyzing costs for CPM versus surveillance in patients with sporadic breast cancer reveal disparate findings:
  • An initial Markov model study found that CPM was cost effective compared with surveillance for:
    • Patients younger than 70 years:
      • But this finding was highly dependent on the quality of life assumptions
  • A second study that included operative complications and breast reconstruction costs used a decision-tree model and concluded that:
    • Although CPM resulted in a cost savings over surveillance for women younger than 50 years:
      • It also reduced quality of life years
    • When MRI was inserted in the model as the primary method of screening:
      • The cost-effectiveness of CPM increased
    • Loss of quality of life years was largely attributed to complications from reconstructive procedures
  • The two models differ in the assumptions regarding quality of life:
    • If we assume an improvement in quality of life after CPM:
      • Then CPM could be cost effective
    • Alternatively, if quality of life is decreased,:
      • CPM would not be a cost-effective strategy
• The available data on cost effectiveness for CPM is limited
• Summary:
  • CPM is a cost-effective strategy for women with BRCA mutations
  • At this time, there is insufficient evidence to support the concept of superior cost effectiveness for CPM in women with sporadic breast cancer and the cost effectiveness is highly dependent on the quality of life assumptions
• Reference:
  • Contralateral Prophylactic Mastectomy Consensus Statement from the American Society of Breast Surgeons: Additional Considerations and a Framework for Shared Decision Making. Ann Surg Oncol (2016) 23:3106–3111

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