Can We Still Afford Innovative Surgical Procedures?

Abstract

Introduction Hospitals are currently facing major financial challenges. Due to the high incidence of breast cancer and the complex range of associated services, surgical treatment of breast cancer is a particular case in point when it comes to the question of cost coverage for innovative versus established procedures by the service providers. The aim of this study is to shed light from a healthcare economics perspective on the current situation of hospitals in Germany with regard to their different structures and processes for breast-conserving therapy.

Materials and methods An online questionnaire with 46 questions was developed and made available to hospitals that are members of the AGO [German Working Group for Gynecological Oncology] Breast Committee and AWOgyn [German Working Group for Cosmetic, Plastic and Reconstructive Surgery in Gynecology], as well as AG-certified breast centers. The questions cover various parameters for health economics analysis, including primary case numbers, structures, and questions about tumor and sentinel marking and surgical procedures.

Results 142 hospitals or breast centers took part in the survey. 93% of the hospitals were certified. The average number of primary cases was 264.6 per year. In over 60% of the hospitals, the surgical procedure and surgery planning were influenced by capacity limitations of cooperation partners. “Targeted axillary dissection” was performed in 83.5% of the hospitals, and radioactive markers were most commonly used for sentinel lymph node marking. Over 60% of participating hospitals were highly satisfied with the marking method used.

Conclusion This structure and process analysis now makes it possible to reflect on the costs involved for hospitals of different sizes, in different regions, and with different funding models, and to use this as a basis for the economic evaluation of new surgical procedures within an overall context. In general, it is possible to make savings through innovative procedures in the surgical treatment of breast cancer.

Keywords

Breast cancer - Health economics - Surgical therapy - cost recovery - sentinel node biopsy

Publication History

Article published online:
16 June 2023

• References

• 1 Luengo-Fernandez R, Leal J, Gray A. et al. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 2013; 14: 1165-1174 DOI: 10.1016/S1470-2045(13)70442-X. (PMID: 24131614)
• 2 Marckmann G. Ökonomisierung im Gesundheitswesen als organisationsethische Herausforderung. Ethik Med 2021; 33: 189-201 DOI: 10.1007/s00481-021-00642-1.
• 3 Lux MP, Beckmann MW. Organzentren und Zertifizierung: Chancen und Probleme. In: Wallwiener D, Grischke EM, Grischke S, Taran FA, Bastert G. Gynäkologische Onkologie. 8. erw. und völlig überarb. Aufl. Stuttgart: Schattauer; 2017: 439-446
• 4 Lux MP, Nabieva N, Hartkopf AD. et al. Therapy Landscape in Patients with Metastatic HER2-Positive Breast Cancer: Data from the PRAEGNANT Real-World Breast Cancer Registry. Cancers (Basel) 2018; 11 DOI: 10.3390/cancers11010010.
• 5 Beckmann MW, Bader W, Bechtold I. et al. Finanzierung und finanzielle Probleme von Leistungen und Strukturen im Fachgebiet Gynäkologie und Geburtshilfe im Jahr 2011 – DRG-System und stationäre Versorgung inklusive Urogynäkologie und benigner wie auch maligner gynäkologischer Operationen. Geburtshilfe Frauenheilkd 2011; 71: 497-510 DOI: 10.1055/s-0030-1271116.
• 6 Lux M, Hildebrandt T, Beyer-Finkler E. et al. Relevance of health economics in breast cancer treatment – the view of certified breast centres and their patients. Breast Care (Basel) 2013; 8: 15-21 DOI: 10.1159/000347098.
• 7 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF). S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Mammakarzinoms, Version 4.4, 2021, AWMF Registernummer: 032-045OL. Accessed November 10, 2022 at: http://www.leitlinienprogramm-onkologie.de/leitlinien/mammakarzinom/
• 8 IQTIG. Bundesauswertung zum Erfasungsjahr 2020; Mammachirurgie Qualitätsindikatoren und Kennzahlen. Accessed August 10, 2021 at: https://iqtig.org/downloads/auswertung/2020/18n1mamma/QSKH_18n1-MAMMA_2020_BUAW_V01_2021-08-10.pdf
• 9 Ferrucci M, Franceschini G, Douek M. New techniques for sentinel node biopsy in breast cancer. Translational Cancer Research 2018; 7: S405-S417 DOI: 10.21037/tcr.2018.02.07.
• 10 Caudle AS, Yang WT, Krishnamurthy S. et al. Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection. J Clin Oncol 2016; 34: 1072-1078 DOI: 10.1200/JCO.2015.64.0094.
• 11 Gera R, Tayeh S, Al-Reefy S. et al. Evolving Role of Magseed in Wireless Localization of Breast Lesions: Systematic Review and Pooled Analysis of 1,559 Procedures. Anticancer Res 2020; 40: 1809-1815 DOI: 10.21873/anticanres.14135. (PMID: 32234869)
• 12 Kühn F, Simon CEE, Aliyeva I. et al. A German Study Comparing Standard Wire Localization With Magnetic Seed Localization of Non-palpable Breast Lesions. In Vivo 2020; 34: 1159-1164 DOI: 10.21873/invivo.11888.
• 13 AGO. Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome (V.1 2022). Accessed November 10, 2022 at: https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2022/AGO_2022D_Gesamtdatei.pdf
• 14 Friedrich M, Kühn T, Janni W. et al. AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy. Geburtshilfe Frauenheilkd 2021; 81: 1112-1120 DOI: 10.1055/a-1499-8431. (PMID: 34629490)
• 15 Flores-Funes D, Aguilar-Jiménez J, Martínez-Gálvez M. et al. The problem of axillary staging in breast cancer after neoadjuvant chemotherapy. Role of targeted axillary dissection and types of lymph node markers. Cirugía Española (English Edition) 2020; 98: 510-515 DOI: 10.1016/j.cireng.2020.10.012. (PMID: 32386728)
• 16 Boughey JC, Ballman KV, Le-Petross HT. et al. Identification and Resection of Clipped Node Decreases the False-negative Rate of Sentinel Lymph Node Surgery in Patients Presenting With Node-positive Breast Cancer (T0-T4, N1-N2) Who Receive Neoadjuvant Chemotherapy: Results From ACOSOG Z1071 (Alliance). Ann Surg 2016; 263: 802-807 DOI: 10.1097/SLA.0000000000001375.
• 17 Kim EY, Byon WS, Lee KH. et al. Feasibility of Preoperative Axillary Lymph Node Marking with a Clip in Breast Cancer Patients Before Neoadjuvant Chemotherapy: A Preliminary Study. World J Surg 2018; 42: 582-589 DOI: 10.1007/s00268-017-4171-8.
• 18 Reitsamer R, Peintinger F, Forsthuber E. et al. The applicability of Magseed(R) for targeted axillary dissection in breast cancer patients treated with neoadjuvant chemotherapy. Breast 2021; 57: 113-117 DOI: 10.1016/j.breast.2021.03.008.
• 19 Douek M, Klaas J, Monypenny I. et al. Sentinel Node Biopsy Using a Magnetic Tracer Versus Standard Technique: The SentiMAG Multicentre Trial. Ann Surg Oncol 2014; 21: 1237-1245 DOI: 10.1245/s10434-013-3379-6.
• 20 Zada A, Peek M, Ahmed M. et al. Meta-analysis of sentinel lymph node biopsy in breast cancer using the magnetic technique. Br J Surg 2016; 103: 1409-1419 DOI: 10.1002/bjs.10283. (PMID: 27611729)
• 21 DAZ.online. Radiopharmaka-Engpass im November: Technetium soll knapp werden – technische Probleme an Forschungsreaktor. Accessed November 15, 2022 at: https://www.deutsche-apotheker-zeitung.de/news/artikel/2022/11/15/technische-probleme-an-forschungsreaktor-technetium-soll-knapp-werden