G. Struik (Delft, Netherlands)
Reinier de Graaf GasthuisAuthor Of 2 Presentations
77P - the cost effectiveness and cosmetic outcome of vacuum assisted excision compared to surgical excision for the treatment of benign and high-risk lesions
Abstract
Background
In this study we will, compare VAE with surgical excision for the treatment of benign and high risk lesions, regarding cosmetic outcome and direct health care costs.
Methods
This was a retrospective cohort study, data was collected from electronic patient files in the period between January 2016 and December 2019. VAE was introduced in our hospital (a large teaching hospital) as a treatment for benign and high-risk lesions in July 2017. Cosmetic outcome was measured with the BCTOS cosmetic subscale and presented as an unweighted mean score. Health care costs were presented as mean (SD) and the difference between the two groups (VAE or SE).
Results
Between January 2016 and December 2018, 280 patients were treated for 329 benign or high-risk lesions in our hospital. The initial procedure was a VAE in 104 patients. Mean cosmetic outcome score was not significantly different for VAE (mean 1.54, SD 0.45) compared to SE (mean 1.51, SD 0.45) (p = 0.544). If patients were initially treated with VAE, the total costs of treatment were lower than when patients were initially treated with SE (mean difference € 2527,81). The biggest differences in costs were seen in the procedural and procedure related costs. Even after correcting for tumor size, the number of resected tumors per patient, the number of procedures per patient, the presence of complications, BI-RADS category and the follow-up time, the difference between VAE and SE remained significant (β = -0.65, p < 0.001). All but one of the patients that underwent both VAE and SE preferred VAE over SE, due to the less invasive character of the treatment.
Conclusions
This is the first study in which the cosmetic outcome and direct health care costs of VAE and surgical excision are compared. Health care related costs are significantly lower for patients initially treated with VAE without compromising cosmetic outcome. The health care costs of patients undergoing surgical resection were more than double the costs of patients undergoing a VAE. Implicating that if VAE would be used in more high-risk lesions possibly resulting in more surgical re-excisions due to upgrading of the lesions, VAE might still be cost-effective.
Legal entity responsible for the study
Franciscus Gasthuis & Vlietland.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
86P - The impact of the introduction of vacuum assisted excision on clinical management and outcomes of benign and high-risk lesions
Abstract
Background
The use of VAE for high-risk lesions remains controversial and guidelines are ambiguous. In this study we evaluate and demonstrate how the introduction of VAE impacts the management and clinical outcomes of benign and high-risk lesions in our hospital.
Methods
A retrospective database cohort study was conducted to compare the available operation room time, and excision, re-excision, recurrence, complications and upgrading rates before and after the introduction of VAE. All patients treated for a benign or high-risk lesion in the period from January 2016 up to 2019 were included in the study. To demonstrate the difference in treatment the results for VAE and surgical excision (SE) in the after group were presented separately.
Results
A total of 319 lesions were excised in our hospital during the study period, of which 118 were excised through VAE. The proportion of excised lesions was comparable in the before and after group, but the proportion of SE decreased since the introduction of VAE. High-risk lesions were significantly more often treated with SE than VAE due to the high rate of surgically excised papillary lesions. Recurrence, re-excision and complication rates were comparable in the before and after group. Nearly all malignancies found after excision through VAE or SE were good differentiated in situ carcinoma, and no malignancies were detected during the follow-up of benign and high-risk lesions.
Conclusions
The introduction of VAE reduced OR time for benign and high-risk lesions, implicating that more OR time was available for malignant lesions. Re-excision, recurrence and upgrade rates remained low and could possibly be further reduced by better informing the patient prior to the procedure. This study contributes to the accumulating evidence for the wider deployment of VAE as a treatment option for all high-risk lesions.
Legal entity responsible for the study
Franciscus Gasthuis en Vlietland.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.