Rachel Wood

NSG 471

Professor Nena Powell

Module 3 Assignment

24 February 2024

Pham, P. D., Muchadeyi, M. T., & Lindholm, L. (2023). In situ breast cancer surgeries in

Sweden: lumpectomy or mastectomy?—a cost-effectiveness analysis over a 30-Year

period using Markov model. Cost Effectiveness & Resource Allocation, 21(1), 1–13.

https://doi.org/10.1186/s12962-023-00495-z

Breast cancer is a prevalent form of cancer that originates in the ducts or lobules of the

breast tissue. In the case of in situ carcinoma, the abnormal cells remain confined to the breast

ducts or lobules without invading surrounding tissue. This study specifically focuses on in situ

carcinoma of the breast. Treatment options for this condition include, mastectomy, lumpectomy,

and lumpectomy with irradiation therapy. Lumpectomy is a breast conserving surgery (BCS), so

the cancerous tissue is removed and the rest of the breast is spared. While mastectomy is the

complete removal of the breast. The research question in this scientific article is to determine the

best surgical treatment option for in situ breast cancer, taking into account cost-effectiveness and

weighing quality-adjusted life years (QALYs), which are used to measure the effectiveness of

treatment in terms of improving quality of life.

The study was conducted using a mathematical tool called the Markov model, to analyze

how different surgeries affect the outcomes of in situ breast cancer treatment in Sweden. The

model was adapted from a previous study and built in Microsoft Excel. The model displays real-

world data and reflects what happens to patient’s after their first surgery, and considers different
health states like remission and being cancer-free. Overall, this model helps to understand which

surgical option is best for treating in situ breast cancer.

The study revealed several findings regarding the effectiveness and cost-effectiveness of

the treatment options. Although initially both lumpectomy options had similar QALY rates, over

the 30-year period, there was a significant difference between lumpectomy with and without

radiation. A lumpectomy with radiation is more expensive due to the additional treatment after

surgery, however it also yields the highest estimated QALY. Mastectomy was dominated by both

lumpectomy surgeries, this is because mastectomy resulted in the lowest QALYs while also

incurring the highest costs This indicates that mastectomy should only be considered if a

lumpectomy isn’t possible, this can happen when the cancer is widespread, extensive, or when a

lumpectomy has been performed but failed to clear the surgical margins of cancerous cells.

The study has some limitations that need to be recognized. Firstly, it acknowledges

limited information about the demographics and clinical characteristics of the patients involved.

This makes it harder to analyze other factors that might affect the choice of surgery and its

outcomes. Without this information, t's difficult to say if the findings apply to different groups of

people. It also makes it difficult to identify any other factors that could be influencing the results.

Despite its limitations, the study provides important insights into the effectiveness and

costs of different in situ breast cancer surgeries. While lumpectomy with radiation may incur

higher expenses, it leads to better quality of life outcomes when compared to a lumpectomy

without radiation. It also revealed that mastectomy is found to have lower quality of life

outcomes and higher costs, this leads to the recommendation of only choosing this route if a

lumpectomy is not feasible. The study provides valuable information and guidance for patients

and providers in order to make decisions about breast cancer treatment.