Cost Effectiveness Comparison of Implementing Intraoperative Margin Assessment using Radiofrequency Spectroscopy or Full Cavity Shave Margins to Reduce Re-excision in Breast Conserving Surgery: A Pro-Forma

Abstract

Abstract Background: In an effort to reduce positive margins and subsequent re-excisions after breast conserving surgery (BCS), many providers utilize either a Full Cavity Shave (FCS) approach or intraoperative margin assessment using MarginProbe Radiofrequency Spectroscopy. Although both FCS and MarginProbe have been shown to reduce positive margins by ³50%, little has been reported about their economic impacts. We created a functioning Pro-Forma for use by facilities and payers to evaluate the cost-effectiveness of implementing FCS or MarginProbe. Methods: A decision tree demonstrating three possible surgical pathways, BCS, BCS+FCS, and BCS+MarginProbe was developed with clinical inputs for re-excision rate, rate of mastectomy conversion, and rate of breast reconstruction derived from literature review. A pathway cost formula was created using the decision tree and financial inputs derived from the nation’s largest database of private payor and Medicare claims data (fairhealth.org). This data was utilized to create a customizable Pro-Forma for cost-effectiveness analysis. Results: In the privately insured population, MarginProbe provides a cost-savings over BCS alone when baseline re-excision rates are over 20% and FCS becomes cost-saving when baseline re-excision rates are over 29%. For Medicare patients, MarginProbe provides a cost-savings when baseline re-excision rates exceed 34%, and FCS becomes cost-saving for re-excision rates over 52%. Conclusions: Utilizing either an FCS approach or the MarginProbe system may be cost-effective solutions to reducing breast re-excisions rates depending on surgical volume and baseline re-excision rates. The degree of cost effectiveness of these interventions for healthcare facilities and payers can be evaluated using the Pro-Forma outlined herein.