The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer

Background: Contralateral prophylactic mastectomy (CPM) may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of CPM in women with early stage unilateral breast cancer. Given finite healthcare resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. Study Design: Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with CPM and immediate breast reconstruction (IBR) were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups. Results: A total of 2,343 women were identified who met our inclusion criteria with 1,295 undergoing unilateral mastectomy and 1,048 undergoing CPM. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and CPM (39% vs. 42%, p=0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. CPM with reconstruction was an additional $11,872 in expenditure (p