Corrigendum to “Cost and Complications of Local Therapies for Early-Stage Breast Cancer” by Bengamin D. Smith et al. JNCI. J Natl Cancer Inst. Vol. 109, Issue 1, 2017. doi: 10.1093/jnci/djw178.
In the process of working on a subsequent manuscript, an error in the code written to define the MarketScan cohort was identified. Correcting this error has resulted in a lower total number of patients included in the MarketScan cohort, now n = 40 174 compared to 44 344 in the original publication. The reduction in cohort size is primarily due to a lower number of patients treated with mastectomy alone, now n = 6357, compared to 11 432 in the original publication (see Table 1, revised).
Table 1.
(Revised). Baseline characteristics by local treatment strategy for the MarketScan cohort*
| Lump+WBI (n = 17 550) |
Lump + Brachy (n = 2414) |
Lump alone (n = 2229) |
Mast alone (n = 6357) |
Mast+Recon (n = 11 624) |
||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Variable | No. | (%) | No. | (%) | No. | (%) | No. | (%) | No. | (%) |
| Age, y | ||||||||||
| <40 | 615 | 3.5 | 5 | .2 | 187 | 8.4 | 169 | 2.7 | 1221 | 10.5 |
| 40–49 | 4720 | 26.9 | 395 | 16.4 | 770 | 34.5 | 1221 | 19.2 | 4396 | 37.8 |
| 50–59 | 9096 | 51.8 | 1413 | 58.5 | 1009 | 45.3 | 3376 | 53.1 | 4870 | 41.9 |
| 60–64 | 3119 | 17.8 | 601 | 24.9 | 263 | 11.8 | 1591 | 25.0 | 1137 | 9.8 |
| Type of coverage | ||||||||||
| non-HMO | 14 430 | 82.2 | 2075 | 86.0 | 1829 | 82.1 | 5093 | 80.1 | 9419 | 81.0 |
| HMO | 3120 | 17.8 | 339 | 14.0 | 400 | 18.0 | 1264 | 19.9 | 2205 | 19.0 |
| Covered individual | ||||||||||
| Employee | 10 848 | 61.8 | 1524 | 63.1 | 1278 | 57.3 | 3726 | 58.6 | 6779 | 58.3 |
| Dependent | 6702 | 38.2 | 890 | 36.9 | 951 | 42.7 | 2631 | 41.4 | 4845 | 41.7 |
| Comorbidity | ||||||||||
| 0 | 15 860 | 90.4 | 2143 | 88.8 | 1993 | 89.4 | 5492 | 86.4 | 10 749 | 92.5 |
| 1 | 1458 | 8.3 | 230 | 9.5 | 187 | 8.4 | 707 | 11.1 | 757 | 6.5 |
| ≥2 | 232 | 1.3 | 41 | 1.7 | 49 | 2.2 | 158 | 2.5 | 118 | 1.0 |
| Year | ||||||||||
| 2000 | 271 | 1.5 | 4 | .2 | 110 | 4.9 | 244 | 3.8 | 226 | 1.9 |
| 2001 | 303 | 1.7 | 1 | .0 | 102 | 4.6 | 255 | 4.0 | 241 | 2.1 |
| 2002 | 338 | 1.9 | 9 | .4 | 140 | 6.3 | 397 | 6.3 | 328 | 2.8 |
| 2003 | 644 | 3.7 | 50 | 2.1 | 202 | 9.1 | 525 | 8.3 | 533 | 4.6 |
| 2004 | 847 | 4.8 | 65 | 2.7 | 207 | 9.3 | 459 | 7.2 | 602 | 5.2 |
| 2005 | 1167 | 6.7 | 94 | 3.9 | 236 | 10.6 | 530 | 8.3 | 755 | 6.5 |
| 2006 | 1255 | 7.2 | 184 | 7.6 | 211 | 9.5 | 541 | 8.5 | 823 | 7.1 |
| 2007 | 2005 | 11.4 | 332 | 13.8 | 216 | 9.7 | 696 | 11.0 | 1277 | 11.0 |
| 2008 | 1975 | 11.3 | 391 | 16.2 | 182 | 8.2 | 639 | 10.1 | 1327 | 11.4 |
| 2009 | 2904 | 16.6 | 436 | 18.1 | 260 | 11.7 | 725 | 11.4 | 1836 | 15.8 |
| 2010 | 3095 | 17.6 | 448 | 18.6 | 205 | 9.2 | 739 | 11.6 | 1907 | 16.4 |
| 2011 | 2746 | 15.7 | 400 | 16.6 | 158 | 7.1 | 607 | 9.6 | 1769 | 15.2 |
| Chemotherapy | ||||||||||
| No | 10 742 | 61.2 | 1946 | 80.6 | 1902 | 85.3 | 3557 | 56.0 | 7337 | 63.1 |
| Yes | 6808 | 38.8 | 468 | 19.4 | 327 | 14.7 | 2800 | 44.1 | 4287 | 36.9 |
| Trastuzumab | ||||||||||
| No | 16 454 | 93.8 | 2328 | 96.4 | 2199 | 98.7 | 5928 | 93.3 | 10 861 | 93.4 |
| Yes | 1096 | 6.3 | 86 | 3.6 | 30 | 1.4 | 429 | 6.8 | 763 | 6.6 |
| Axillary surgery | ||||||||||
| No | 3631 | 20.7 | 531 | 22.0 | 1503 | 67.4 | 684 | 10.8 | 1869 | 16.1 |
| Yes | 13 919 | 79.3 | 1883 | 78.0 | 726 | 32.6 | 5673 | 89.2 | 9755 | 83.9 |
| Bilateral mastectomy | ||||||||||
| No | 17 550 | 100 | 2414 | 100 | 2229 | 100 | 5701 | 89.7 | 8128 | 69.9 |
| Yes | 0 | 0 | 0 | 0 | 0 | 0 | 656 | 10.3 | 3496 | 30.1 |
| Node positive | ||||||||||
| No | 15 261 | 87.0 | 2356 | 97.6 | 2100 | 94.2 | 5185 | 81.6 | 10 174 | 87.5 |
| Yes | 2289 | 13.0 | 58 | 2.4 | 129 | 5.8 | 1172 | 18.4 | 1450 | 12.5 |
| Endocrine therapy | ||||||||||
| No | 7127 | 40.6 | 913 | 37.8 | 1641 | 73.6 | 3018 | 47.5 | 6313 | 54.3 |
| yes | 10 423 | 59.4 | 1501 | 62.2 | 588 | 26.4 | 3339 | 52.5 | 5311 | 45.7 |
*P value < .001 (chi-square) for all comparisons of treatment strategy by patient and treatment characteristics. Brachy = brachytherapy; HMO = Health Maintenance Organization; Lump = lumpectomy; Mast = mastectomy; WBI = whole breast irradiation.
To reflect these changes, the analyses in the manuscript for the MarketScan cohort have been revised. Figure 1A remains qualitatively similar to the original figure included in the published manuscript. The key finding presented in Table 2, specifically an excess risk of complications with mastectomy and reconstruction compared to lumpectomy and whole breast irradiation, remains essentially unchanged (relative risk [RR] = 1.79, 95% confidence interval [CI] = 1.75 to 1.83; P <.001). The only meaningful change to Table 2 is that treatment with mastectomy alone is no longer associated with a lower risk of any local treatment complication (RR = 1.03, 95% CI = 1.00 to 1.07; P = .09). Table 3 has been updated and key findings remain stable, for example the adjusted mean complication cost is $9708 (95% CI = 8401 to 11 017) with mastectomy and reconstruction and $1336 (95% CI = 1193 to 1479) with lumpectomy and whole breast irradiation. Figure 2A has been updated as well, with key findings qualitatively similar.
Figure 1A.
Complications by year of diagnosis and local therapy (unadjusted) for the Marketscan cohort. Unadjusted time trends in risk of any complication by type of local therapy. Data for lumpectomy plus brachytherapy in 2000 and 2001 are not shown because of small numbers (n=5). WBI = whole breast irradiation.
Table 2.
Logistic regression model for any local treatment complication*
| Variable | RR (95% CI) | P |
|---|---|---|
| Local therapy | ||
| Lump+WBI | 1 (Ref) | |
| Lump+Brachy | 1.43 (1.38 to 1.49) | <.001 |
| Lump alone | 1.07 (1.01 to 1.14) | .01 |
| Mast alone | 1.03 (1.00 to 1.07) | .09 |
| Mast+Recon | 1.79 (1.75 to 1.83) | <.001 |
| Age, y | ||
| <40 | 1 (Ref) | |
| 40–49 | 1.02 (.96 to 1.09) | .42 |
| 50–59 | 1.03 (.97 to 1.08) | .37 |
| 60–64 | 1.04 (.98 to 1.10) | .24 |
| Comorbidity | ||
| 0 | 1 (Ref) | |
| 1 | 1.25 (1.20 to 1.30) | <.001 |
| 2 or higher | 1.37 (1.26 to 1.48) | <.001 |
| Chemotherapy | ||
| None | 1 (Ref) | |
| Without trastuzumab | 1.09 (1.06 to 1.12) | <.001 |
| With trastuzumab | 1.15 (1.09 to 1.21) | <.001 |
*No patients were excluded. RR = relative risk; CI = confidence interval; Brachy = brachytherapy; Lump = lumpectomy; Mast = mastectomy; Recon = reconstruction; WBI = whole breast irradiation. All P values were two=sided and calculated in the logistic regression models.
Table 3.
Unadjusted and Adjusted 2-year Costs by Local Therapy Strategy, Diagnosis years 2010-2011*
| Unadjusted costs, $ |
Adjusted costs, $ |
|||||||
|---|---|---|---|---|---|---|---|---|
| Total |
Complication | Noncomplication |
Total | Complication | Noncomplication | |||
| Treatment | Mean (95% CI) | Median (IQR) | Mean (95% CI) | Mean (95% CI) | Median (IQR) | Mean (95% CI) | Mean (95% CI) | Mean (95% CI) |
| Lump+WBI | 77 314 (75 772 to 78 856) | 60 266 (41 228 to 93 905) | 1358 (1205 to 1511) | 75 883 (74 367 to 77 401) | 59 210 (40 374 to 91 950) | 68 841 (67 622 to 70 061) | 1336 (1193 to 1479) | 67 225 (66 043 to 68 407) |
| Lump+Brachy | 72 184 (68 637 to 75 732) | 60 339 (39 424 to 89 279) | 1631 (1241 to 2021) | 70 467 (66 970 to 73 963) | 58 805 (38 340 to 87 453) | 80 299 (76 554 to 84 045) | 1672 (1201 to 2142) | 78 621 (74 983 to 82 259) |
| Lump alone | 63 860 (56 672 to 71 048) | 53 996 (23 984 to 86 311) | 2493 (1676 to 3310) | 60 183 (53 012 to 67 354) | 46 983 (20 166 to 81 777) | 76 313 (69 803 to 82 823) | 2604 (1476 to 3732) | 73 595 (67 368 to 79 823) |
| Mast alone | 62 229 (58 855 to 65 602) | 40 203 (21 332 to 81 796) | 2630 (1826 to 3434) | 59 481 (56 294 to 62 668) | 38 278 (20 193 to 78 658) | 52 586 (50 749 to 54 423) | 2489 (1960 to 3018) | 50 081 (48 351 to 51 812) |
| Mast+Recon | 96 010 (93 569 to 98 451) | 75 725 (49 456 to 117 680) | 9552 (8759 to 10 345) | 85 956 (83 687 to 88 225) | 66 404 (43 117 to 105 221) | 90 986 (88 925 to 93 046) | 9708 (8401 to 11 017) | 80 187 (78 379 to 81 995) |
Adjusted costs are adjusted for the variables listed in Table 1. Each cost model was iteratively refined to remove covariables that did not statistically significantly contribute to the model. No patients were excluded from any calculation. All figures are reported in 2014 dollars. Brachy = brachytherapy; CI = confidence interval; Lump = lumpectomy; Mast = mastectomy; Recon = reconstruction; WBI = whole breast irradiation.
Figure 2A.
Adjusted total and complication-related cost relative to lumpectomy and whole breast irradiation for patients diagnosed in 2010 and 2011. Adjusted difference in total cost and complication-related cost of local therapy options, relative to lumpectomy plus whole breast irradiation, for patients diagnosed in 2010 and 2011. Brachy = brachytherapy; Lump = lumpectomy; Mast = mastectomy; Recon = reconstruction; SEER = Surveillance, Epidemiology, and End Results; WBI = whole breast irradiation.