Udine University School of Medicine, Italy
Federico Cattin has completed his graduation at the age of 25 in the Udine University, and post-graduate studies in the Surgical Department of the same University. He is engaged in the studies about breast cancer and has attended a scholarship in the European Institute of Oncology (IEO) in Milan, held by Prof. Umberto Veronesi. He has published 13 papers in reputed journals. Nowadays he works in the Sterzing General hospital in South Tyrol, in Italy.
Objectives: In breast cancer therapy diagnostic and therapeutic pathways may differ among different centres. The pathway chosen in our Department includes a stadiation through magnetic resonance imaging (MRI) for all the patients and the sentinel node biopsy (SNB) analysis made through an extemporaneous exam. This, even if more expensive at the beginning, allows in some cases to avoid further interventions. Aim of the study is the cost analysis of three different pathways. Methods: We studied the patients who underwent surgery for breast cancer in our department in the last 5 years (2006-2010); analyzed variables are: execution of MRI, kind and duration of surgery, duration of hospitalization. In case of mismatch MRI/ basic exams (mammography, ultrasonography) or positive SNB, we indicated the necessary second surgery or the axillary lymphadenectomy. We considered the costs of any single procedure and then their sum, hypothesizing then the application of other different pathways to the same group of patients, calculating each one’s cost. Results: 767 Patients, 489 quadrantectomies (63.7%) and 278 mastectomies (36.3%). Positive SNB in 90/559 cases (16.1%). Therapy modification after MRI happened in 63 cases (10.1% of 619 MRI). A single MRI costs 323€, hospitalization 570€/day. Operatory room cost/minute is 9.4€/quadrantectomy, 8.9€/mastectomy. SNB biopsy cost is 112€ if extemporaneous, 107€ if deferred. Surgery made for mistakes due to the absence of MRI exam costs 5394€, postponed axillary lymphadenectomy costs 4081€. The whole cost was 3.825.890€ for our pathway, 3.973.722€ for the one without MRI in every case, 4.339.588€ for the one without MRI in every case and without extemporaneous analysis of SN. Conclusions: Data considering avoided interventions and economic assessments show how, through a better organization, it is possible the objective to improve quality of health care and to cut down on costs.