Systematic Review of the Economic Impact of Re-operation in Breast-Conserving Surgery: Assessment of Quality using the QHES Instrument
Association of Breast Surgery ePoster Library. Al-Khudairi R. 05/15/17; 166287; P070
Dr. Rashed Al-Khudairi
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Abstract
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Introduction: Close or positive margins following breast-conserving surgery (BCS) result in an average national reoperative breast surgery rate of 20%. The cost burden associated with re-excision is poorly described, with limited evidence detailing the economic impact of reoperation. The objective of this study was to appraise the quality of evidence on BCS re-excision costs using the Quality of Health Economics Study (QHES) instrument.
Methods: Electronic bibliographic searches of EMBASE, Medline, Scopus and HMIC using all field search terms of “breast cancer” AND “margin” AND “reoperation” AND (“cost” OR “economic”) were performed. Only studies published from 2006-2016 that evaluated costs of reoperation following BCS were included. Using the QHES instrument a panel of reviewers independently determined the quality of studies, assigning weighted scores according to a 0-100 scale.
Results: 129 unique studies revealed 7 studies that fulfilled the inclusion criteria for the qualitative synthesis. There were no studies estimating costs in UK populations. Only direct medical costs were reported, whilst indirect and intangible costs were not estimated. All studies included costs in the peri-operative phase with n=6 using cost benefit analysis and n=1 using a cost minimisation approach. The resulting QHES scores ranged from 36 to 95 with a mean of 67.1 (SD=20.2). Only 3 papers had scores greater than 75.
Conclusion: This review highlights the lack of high-quality evidence on the cost of margin re-excision. A framework for economic evaluations in BCS is required to improve future study designs in this field.
Methods: Electronic bibliographic searches of EMBASE, Medline, Scopus and HMIC using all field search terms of “breast cancer” AND “margin” AND “reoperation” AND (“cost” OR “economic”) were performed. Only studies published from 2006-2016 that evaluated costs of reoperation following BCS were included. Using the QHES instrument a panel of reviewers independently determined the quality of studies, assigning weighted scores according to a 0-100 scale.
Results: 129 unique studies revealed 7 studies that fulfilled the inclusion criteria for the qualitative synthesis. There were no studies estimating costs in UK populations. Only direct medical costs were reported, whilst indirect and intangible costs were not estimated. All studies included costs in the peri-operative phase with n=6 using cost benefit analysis and n=1 using a cost minimisation approach. The resulting QHES scores ranged from 36 to 95 with a mean of 67.1 (SD=20.2). Only 3 papers had scores greater than 75.
Conclusion: This review highlights the lack of high-quality evidence on the cost of margin re-excision. A framework for economic evaluations in BCS is required to improve future study designs in this field.
Introduction: Close or positive margins following breast-conserving surgery (BCS) result in an average national reoperative breast surgery rate of 20%. The cost burden associated with re-excision is poorly described, with limited evidence detailing the economic impact of reoperation. The objective of this study was to appraise the quality of evidence on BCS re-excision costs using the Quality of Health Economics Study (QHES) instrument.
Methods: Electronic bibliographic searches of EMBASE, Medline, Scopus and HMIC using all field search terms of “breast cancer” AND “margin” AND “reoperation” AND (“cost” OR “economic”) were performed. Only studies published from 2006-2016 that evaluated costs of reoperation following BCS were included. Using the QHES instrument a panel of reviewers independently determined the quality of studies, assigning weighted scores according to a 0-100 scale.
Results: 129 unique studies revealed 7 studies that fulfilled the inclusion criteria for the qualitative synthesis. There were no studies estimating costs in UK populations. Only direct medical costs were reported, whilst indirect and intangible costs were not estimated. All studies included costs in the peri-operative phase with n=6 using cost benefit analysis and n=1 using a cost minimisation approach. The resulting QHES scores ranged from 36 to 95 with a mean of 67.1 (SD=20.2). Only 3 papers had scores greater than 75.
Conclusion: This review highlights the lack of high-quality evidence on the cost of margin re-excision. A framework for economic evaluations in BCS is required to improve future study designs in this field.
Methods: Electronic bibliographic searches of EMBASE, Medline, Scopus and HMIC using all field search terms of “breast cancer” AND “margin” AND “reoperation” AND (“cost” OR “economic”) were performed. Only studies published from 2006-2016 that evaluated costs of reoperation following BCS were included. Using the QHES instrument a panel of reviewers independently determined the quality of studies, assigning weighted scores according to a 0-100 scale.
Results: 129 unique studies revealed 7 studies that fulfilled the inclusion criteria for the qualitative synthesis. There were no studies estimating costs in UK populations. Only direct medical costs were reported, whilst indirect and intangible costs were not estimated. All studies included costs in the peri-operative phase with n=6 using cost benefit analysis and n=1 using a cost minimisation approach. The resulting QHES scores ranged from 36 to 95 with a mean of 67.1 (SD=20.2). Only 3 papers had scores greater than 75.
Conclusion: This review highlights the lack of high-quality evidence on the cost of margin re-excision. A framework for economic evaluations in BCS is required to improve future study designs in this field.
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