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. 2018 Jan 12;6(1):e1552.
doi: 10.1097/GOX.0000000000001552. eCollection 2018 Jan.

Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis

Parisa Kamali  1 , Joseph A Ricci  1 , Daniel A Curiel  1 , Justin B Cohen  1 , Anmol Chattha  1 , Hinne A Rakhorst  1 , Bernard T Lee  1 , Samuel J Lin  1
Affiliations

Immediate Breast Reconstruction among Patients with Medicare and Private Insurance: A Matched Cohort Analysis

Parisa Kamali et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: By eliminating economic hurdles, the Women's Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and comorbidities between a younger privately insured and an older Medicare population. We examined immediate breast reconstruction (IBR) utilization between a matched pre- and post-Medicare population.

Methods: Using the Nationwide Inpatient Sample database (1992-2013), breast cancer patients undergoing IBR were identified. To minimize confounding medical variables, 64-year-old privately insured women were compared with 66-year-old Medicare-insured women. Demographic data, IBR rates, and complication rates were compared. Trend over time was plotted for both cohorts.

Result: A total of 21,402 64-year-old women and 25,568 66-year-old women were included. Both groups were well matched in terms of demographic type of reconstruction and complication rates. 72.3% of 64-year-old and 71.2 of % 66-year-old women opted for mastectomy. Of these, 25.5% (n = 3,941) of 64-year-old privately insured and 17.7% (n = 3,213) of 66-year-old Medicare-insured women underwent IBR (P < 0.01). During the study period, IBR rates increased significantly in both cohorts in a similar cohort.

Conclusion: This study demonstrates significant increasing IBR rates in both cohorts. Moreover, after an initial slower upward trend, after a decade, IBR in 66-year-old Medicare-insured women approached similar rates of breast reconstruction among those with private insurance. Trends in unilateral versus bilateral mastectomy are also seen.

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Figures

Fig. 1.
Fig. 1.
Rates of unilateral and bilateral mastectomy among (A) 64-year-old privately insured women and (B) 66-year-old Medicare-insured women. Cochrane–Armitage test for trend, P < 0.001 in both cohorts.
Fig. 2.
Fig. 2.
Rates of IBR over study period. Cochrane–Armitage test for trend, P < 0.001 in both cohorts.
Fig. 3.
Fig. 3.
Differences of privately insured cohort IBR rates compared with Medicare-insured cohort IBR rates.
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References

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