For the MarketScan cohort, risk of any complication was: 30 percent for lump+WBI; 45 percent for lump+brachy; 25 percent for mast alone and 54 percent for mass+recon. For the SEER-Medicare cohort, risk of any complication was: 38 percent for lump+WBI; 51 percent for lump+brachy; 37 percent for mast alone; 66 percent for mast+recon and 31 percent for lump alone. In both age groups, risk of complications with mast+recon was nearly twice that of lump+WBI.

Compared to lump+WBI, complication-related costs were approximately $9,000 and $2,000 higher with mast+recon for younger women with private insurance and older women with Medicare, respectively. In contrast, complication-related costs were similar for all other local therapy options, relative to lump+WBI, in both cohorts.


Mast+recon was the most expensive therapy (total cost within two years of diagnosis) in the younger population at approximately $88,000, which was $22,000 more expensive than lump+WBI. In the older population, lump+brachy was the most expensive therapy, at approximately $38,000, compared to mast+recon, at $36,000, and lump+WBI, at $34,000.

Of note, said Smith, is that cost data in the study is from 2010 and 2011 only. Smith found the study results shocking, especially the finding that the average insurance company of patients who chose mast+recon pays approximately $10,000 over two years to manage the complications of that procedure.

He says that these findings should be helpful for patients who could choose either therapy to understand the tradeoffs for them, their physicians, as well as for those who are paying for their care.

“What we show for the first time is that while the patient is undergoing more surgery, she is also taking on a considerable amount of risk with regard to what could happen. If the patient can have a lumpectomy and radiation, it may be a smoother course than going through a mastectomy, reconstruction and potentially other surgeries,” explained Smith.

Understanding this type of data is fundamental to health care entities and insurers to think about how they can get the most value for their investment in treating early breast cancer in their patient population. Smith thinks that this type of data will provide guidance for insurance companies as they start to think about bundled payments for breast cancer care.

Despite the findings, Smith stresses that for some patients with early breast cancer, mast+recon is truly their best treatment option, and that these research findings should not be used to decrease reimbursement or coverage for mast+recon when medically indicated.

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