Patient Out‐of‐Pocket Costs and Healthcare Utilization Related to Mastectomy vs Breast Conservation: A Claims‐Based Study

BACKGROUND AND OBJECTIVES: Out-of-pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy. METHODS: Women aged 18-64 who underwent upfront breast cancer surgery were identified from the IBM MarketScan Commercial Claims Database (2014-2017). Surgical groups included lumpectomy+radiation; unilateral mastectomy + /-reconstruction, and bilateral mastectomy + /-reconstruction. Cumulative OOP payments were assessed at 12-month intervals over 4 years postoperatively and adjusted to 2017 USD. Multivariable regression identified factors associated with increased OOP costs. RESULTS: Overall, 23, 159 underwent lumpectomy with radiation (60%), unilateral mastectomy with (15%) and without (6%) reconstruction, and bilateral mastectomy with (17%) and without (2. 6%) reconstruction. Women undergoing bilateral mastectomy+reconstruction were younger than other surgical groups (median age 49 vs. 50-55). In the first year after diagnosis, 1. 24 million outpatient visits occurred, 27% of enrollees had inpatient admissions, 23% visited an E. R. , and median OOP costs were 5669 (range 0 to 132 125). Cumulative costs were significantly higher in women < 45 yo and for those with greater comorbidities. Median OOP costs declined over time (0-12 months: 3661 vs 48 months: 486). OOP costs were 12% higher (8. 9%-15. 1%) with mastectomy+reconstruction than lumpectomy+radiation (6529 vs 5333). CONCLUSIONS: Out-of-pocket costs and healthcare utilization differ between equally effective surgical treatment options; mastectomy + reconstruction is costlier for patients than breast conservation.