Abstract：
OBJECTIVE: Benign breast masses represent a substantial proportion of breast cancer screening results and may require multiple follow-up visits and biopsy. Even with a preceding benign core biopsy, benign masses have been excised via open surgery for a variety of reasons. This study compared the procedural costs of US-guided vacuum-assisted excision (US-VAE) versus open surgical excisions for benign breast masses and high-risk lesions (HRL).
METHODS: In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective.
RESULTS: A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001).
CONCLUSIONS: Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.
METHODS: In this retrospective cohort study, female outpatients receiving US-VAE or open excision of benign breast masses between 2015 and 2018 were identified within the Premier Healthcare Database. A secondary analysis was conducted for patients with HRLs. Propensity score matching and multivariate regression adjusted for patient demographics, encounter level covariates, and hospital characteristics. The total procedural costs were reported from a hospital perspective.
RESULTS: A total of 33 724 patients underwent excisions for benign breast masses (8481 US-VAE and 25 242 open surgery). Procedural costs were significantly lower in unmatched patients who received US-VAE ($1350) versus open surgery ($3045) (P < 0.0001). After matching, a total of 5499 discharges were included in each group, with similar findings for US-VAE ($1348) versus open surgery ($3101) (P < 0.0001). A secondary analysis of matched HRL patients (41 discharges in each group) also showed significantly lower procedural costs with US-VAE ($1620) versus open surgery ($3870) (P < 0.0001).
CONCLUSIONS: Among patients with benign breast masses or HRLs, US-VAE was associated with significantly lower procedural costs versus open surgery. If excision is performed and expected clinical outcomes are equal, US-VAE is preferable to reduce costs without compromising the quality of care.
摘要：
目的：良性乳腺肿块占乳腺癌筛查结果的很大比例，可能需要多次随访和活检。即使之前进行了良性核心活检，由于各种原因，良性肿块已通过开放手术切除。这项研究比较了美国引导的真空辅助切除术（US-VAE）与开放手术切除良性乳腺肿块和高危病变（HRL）的手术成本。
方法：在这项回顾性队列研究中，在PremierHealthcare数据库中确定了2015年至2018年期间接受US-VAE或良性乳腺肿块开放切除术的女性门诊患者.对HRLs患者进行二次分析。针对患者人口统计学进行了倾向评分匹配和多元回归调整，遇到水平协变量，医院特色。从医院的角度报告了总的程序成本。
结果：共有33724例患者接受了良性乳腺肿块切除术（8481US-VAE和25242开放性手术）。接受US-VAE（$1350）的未匹配患者的手术费用明显低于开放手术（$3045）（P<0.0001）。匹配后,每组共有5499人出院，US-VAE（1348美元）与开放手术（3101美元）的结果相似（P<0.0001）。对匹配的HRL患者（每组41例出院）的二次分析也显示，US-VAE（$1620）与开放手术（$3870）相比，手术费用显着降低（P<0.0001）。
结论：在良性乳腺肿块或HRLs患者中，与开放手术相比，US-VAE与手术成本显着降低相关。如果进行了切除，并且预期的临床结果相等，US-VAE优选在不损害护理质量的情况下降低成本。
方法：在这项回顾性队列研究中，在PremierHealthcare数据库中确定了2015年至2018年期间接受US-VAE或良性乳腺肿块开放切除术的女性门诊患者.对HRLs患者进行二次分析。针对患者人口统计学进行了倾向评分匹配和多元回归调整，遇到水平协变量，医院特色。从医院的角度报告了总的程序成本。
结果：共有33724例患者接受了良性乳腺肿块切除术（8481US-VAE和25242开放性手术）。接受US-VAE（$1350）的未匹配患者的手术费用明显低于开放手术（$3045）（P<0.0001）。匹配后,每组共有5499人出院，US-VAE（1348美元）与开放手术（3101美元）的结果相似（P<0.0001）。对匹配的HRL患者（每组41例出院）的二次分析也显示，US-VAE（$1620）与开放手术（$3870）相比，手术费用显着降低（P<0.0001）。
结论：在良性乳腺肿块或HRLs患者中，与开放手术相比，US-VAE与手术成本显着降低相关。如果进行了切除，并且预期的临床结果相等，US-VAE优选在不损害护理质量的情况下降低成本。
