Annual cost-savings with the implementation of estrogen-receptor-only testing on Ductal Carcinoma in Situ specimens

Am J Surg. 2023 Feb;225(2):304-308. doi: 10.1016/j.amjsurg.2022.09.060. Epub 2022 Oct 19.

Abstract

Background: In DCIS, ER status is an important marker. The utility of concomitant PR testing remains unclear.

Methods: A single-institution retrospective cohort study was performed with a comparative analysis of the NCDB to assess annual cost-savings with omission of routine PR testing. National Medicare payment standards determined PR staining costs to be $124.92.

Results: 150 institutional DCIS cases with receptor data were identified. 104 (69%) were ER+/PR+, 16 (11%) were ER+/PR-, and none were ER-/PR+. Omission of routine PR testing would have resulted in $18,738 saved annually. Within the NCDB, 34,100 DCIS cases had receptor data: 29,277 (85.9%) patients were ER+, and 26,008 (76%) were both ER/PR+. 211 (0.6%) patients were ER-/PR+. Annual national cost-savings with omission of routine PR-testing would have been $4.3 million.

Conclusion: PR testing for DCIS should be reserved only for patients with ER- DCIS undergoing breast conservation to determine the utility of adjuvant endocrine therapy.

Keywords: Cost savings; Ductal carcinoma in situ; Omission of progesterone testing.

MeSH terms

  • Aged
  • Breast Neoplasms* / diagnosis
  • Carcinoma, Ductal, Breast* / pathology
  • Carcinoma, Intraductal, Noninfiltrating* / diagnosis
  • Carcinoma, Intraductal, Noninfiltrating* / pathology
  • Estrogens
  • Female
  • Humans
  • Medicare
  • Receptor, ErbB-2 / analysis
  • Receptors, Estrogen
  • Receptors, Progesterone / analysis
  • Retrospective Studies
  • United States

Substances

  • Estrogens
  • Receptor, ErbB-2
  • Receptors, Estrogen
  • Receptors, Progesterone