Economic implications of widespread expansion of frozen section margin analysis to guide surgical resection in women with breast cancer undergoing breast-conserving surgery

QUESTION ASKED: What would be the economic implications for providers and payers of widespread expansion of the use of intraoperative frozen section analysis of lumpectomy margins to guide surgical re-excision and minimize repeated surgery in women with breast cancer undergoing breast-conserving surgery? SUMMARY ANSWER: Our model suggests that expanding the use of frozen section analysis of margins to guide the intraoperative surgical treatment of women undergoing lumpectomy across all US practices would result in a net annual cost savings for Medicare, Medicaid, and private payers. The increase in cost associated with the performance of frozen section analysis is offset by the decrease in expenditures associated with repeated surgery. METHODS: A health care economic impactmodel was built to assess Medicare,Medicaid, and private payer annual costs associated with breast lumpectomy procedures performed with and without intraoperative frozen section margin analysis. Costs to providers were derived from a previous study on costs associated with frozen section margin analysis, and costs to payers were derived from Medicare reimbursement amounts. A probabilistic sensitivity analysis was run with a Monte Carlo simulation of 10,000 simulations to test the robustness of the model. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: This study does not evaluate costs to the patient; this was due to the varying cost sharing and unknown data regarding the cost of time away from work. REAL-LIFE IMPLICATIONS: Overall, these data imply that, if feasible, expanding intraoperative frozen section analysis to guide the surgical management of breast lumpectomy uniformly across all institutions would be beneficial not only to patients by minimizing the need for another surgery, but also financially for health care payers and, in most cases, providers.