Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine

Hon-Yi Shi; Chiu-Hui Li; Yen-Chen Chen; Chong-Chi Chiu; Hao-Hsien Lee; Ming-Feng Hou

doi:10.1007/s13167-023-00326-4

Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine

EPMA J. 2023 Jun 14;14(3):457-475. doi: 10.1007/s13167-023-00326-4. eCollection 2023 Sep.

Authors

Hon-Yi Shi^{1

2

3

4}, Chiu-Hui Li^{1

5}, Yen-Chen Chen¹, Chong-Chi Chiu^{6

7

8}, Hao-Hsien Lee⁹, Ming-Feng Hou^{10

11}

Affiliations

¹ Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan.
² Department of Business Management, National Sun Yat-Sen University, Kaohsiung, 80420 Taiwan.
³ Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708 Taiwan.
⁴ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402 Taiwan.
⁵ Superintendent Office Secretary Admission Service Center, Health Management and Occupational Safety and Health Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 81267 Taiwan.
⁶ Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan.
⁷ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan.
⁸ Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan.
⁹ Department of Surgery, Chi Mei Medical Center, Liouying, Tainan 73658 Taiwan.
¹⁰ Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No. 100, Shih-Chuan 1St Road, Kaohsiung, 80708 Taiwan.
¹¹ Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan.

PMID: 37605647
PMCID: PMC10439868 (available on 2024-09-01)
DOI: 10.1007/s13167-023-00326-4

Abstract

Purpose: Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer.

Methods: This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010.

Results: All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6 months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10 years after surgery, the patients' QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost-utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained.

Conclusions: TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment.

Supplementary information: The online version contains supplementary material available at 10.1007/s13167-023-00326-4.

Keywords: Breast cancer; Breast conserving surgery; Cost utility analysis; Modified radical mastectomy; Predictive Preventive Personalized medicine (PPPM/3PM); Quality of life; Total mastectomy with transverse rectus abdominis myocutaneous flap.

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