In Situ Breast Cancer Surgeries in Sweden: Lumpectomy or Mastectomy? - A Cost-Utility Analysis in a 30-Year Time Period Using Markov Model

Abstract

Abstract Background:Breast cancer is the most prevalent cancer among Swedish women, and while treatments have progressed significantly over the years, there have been few health economics assessments of these treatments, particularly cost effectiveness analysis. This study was to evaluate the cost-effectiveness of three surgical procedures for in situ breast cancer treatment in Sweden: mastectomy, lumpectomy without irradiation, and lumpectomy with irradiation. Methods:A 6-state Markov model with a 30-year time horizon was used to compare the cost-utility of these three alternatives. Transition probabilities were based on a targeted literature review focusing on available evidence in Sweden and similar contexts. Healthcare and societal perspectives were both considered in cost estimation using the Swedish National Cancer Registry patient data in 2020 (Cancerregistret), and a quality-adjusted life years (QALYs) was used to calculate utility. Probabilistic sensitivity analysis (PSA) was applied to handle uncertainties among the parameters. Results:The results showed that lumpectomy with irradiation are cost-effective compared to lumpectomy without irradiation with an incremental cost effectiveness ratio (ICER) of 402,994 Swedish Krona (SEK) from a healthcare perspective and of 575,833 SEK from a societal perspective. Mastectomy alternative was dominated by the two lumpectomy alternatives, as it was the costliest option and yielded the lowest QALYs over the 30-year period. PSA results also supported the findings. Conclusions:This study conducted a cost-utility analysis of three surgical procedures for in situ breast cancer treatment in Sweden, namely mastectomy, lumpectomy without and with irradiation. Further studies are needed to obtain more reliable parameters in Sweden and increase the consistency of the findings.