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26.02.2015
A breast lift surgery, or mastopexy, corrects the droopy breast by tightening not just the skin but the deeper soft tissue as well. The procedure uses incisions around the border of the nipple-areolar complex, inside the inframammary fold, and vertically between these areas, leading to a scar that resembles an inverted T or nautical anchor. Because women with saggy breasts may also have empty-looking upper cleavage, it is not uncommon to combine breast lift and implants in one surgical setting. Nevertheless, breast lift without implants can still provide impressive results for patients who have the “right” anatomies and realistic motives and expectations.
Breast lift without implants is suitable for patients who are happy with their cup size, although they could choose to have the prostheses in the future should they develop deflated upper poles and want to correct this appearance. Whether or not implants are used at the time of surgery, it is important to reshape the breast tissue and possibly use internal sutures to hold the new contour in place. By tightening the deeper structures of the breast mound, a surgeon is also able to restore projection.
One example is the vertical lift, also referred to as lollipop lift due to the shape of the resulting scars (it eliminates the horizontal incision within the inframammary fold).
There are some considerations when breast augmentation surgery is performed on someone who leads an active lifestyle. For most “average build” patients with or without an active lifestyle, a good rule of thumb is to choose implants not larger than 400-500 cc if they want to achieve a more natural result and minimize the risk of rippling and palpability. Large breasts also bounce more (as high as 5 inches) while running or during treadmill workouts, further contributing to the inconvenience and postural problem, explains Dr. Aside from choosing conservative breast implants sizes, the use of silicone implants can further lead to more natural look and feel.
The most common breast augmentation technique uses the inframammary fold or breast crease as the entry point of implants. Another common approach is the peri-areolar in which a small incision along the lower end of the areola is used, specifically the sharp demarcation between the areola complex and the adjacent normal skin.
For patients who are deemed at increased risk of aggressive scars—such as dark-skinned Asians, Hispanics, and Hispanics—the peri-areolar technique may not be ideal, explains breast augmentation Los Angeles expert Dr. However, there are other variables, such as the implant size and filler material, that should be taken into account as well to determine the most ideal entry point, says the renowned plastic surgeon. A possible approach for patients concerned with aggressive scarring is to place the incision within the armpit’s natural skin fold, an area that is innately resistant to aggressive scarring.
In the past, the trans-axillary or “through the armpit” technique rarely used [prefilled] silicone implants that would require longer incisions.
But with the introduction of Keller Funnel, a cone-shaped device that is squeezed to push the implant forward into the pocket, it has become easier to use silicone implants via trans-axillary approach. Meanwhile, patients with a darker skin might also benefit from the inframammary or “through the breast crease” without having to worry about visible scars.
Another possible compromise is to position the scars on the underside of the bulge of the lower pole so they remain hidden even when the patient’s bikini top accidentally rides higher. Aside from choosing the correct entry point based on the patient’s anatomy and propensity to thick scars, proper wound care and scar treatments such as silicone sheets and creams can further lead to finer, less noticeable scars. There are two basic types of breast implant placement: the subglandular in which the device is only below the tissue, and the submuscular wherein it is positioned underneath the chest muscle as well. However, overs can still deliver natural-looking results to women with adequate breast tissue who opt for a more conservative augmentation or an implant size that is within the boundaries of their underlying anatomies, explains Dr.
Overs tend to stick out more or provide more outward projection than unders or submuscular since the implants are only behind the breast tissue itself, he adds. For women with little tissue, the renowned Los Angeles plastic surgeon generally recommends the submuscular technique that provides an additional coverage from the chest muscle. Contrary to popular belief, the submuscular does not mean that the entire implant is covered by the muscle, says Dr. To counteract the rippling effect, which small-breasted and thin-skinned patients are susceptible to, Dr.
Breast augmentation recovery has several definitions: complete disappearance of pain and discomfort, return to physical activities and social routine, breast implants settling into their final position, scar maturity, and skin redraping to the new contour.
For most patients, the pain after breast augmentation surgery is mild to moderate that oral painkillers are only needed in the first few days. On average, patients are able go back to work a week after surgery if their tasks are not physically demanding. While pain can easily dissipate, lethargy might persist for several weeks because it takes time for the body to heal from any surgery, so some patients may find themselves going to bed earlier than their normal routine because they can easily tire out, explains Dr. But the postop lethargy is not a reason to remain in bed for too long as prolonged immobility after any type of surgery can lead to increased risk of blood clotting in the legs, persistent swelling, chronic fatigue, weight gain, and delayed recovery. The residual swelling also takes time to dissipate, although about a month most of the symptom will be gone.
In addition, the breast implants will take up to six months to settle into their final position and the skin to fully redrape to the new contour, making it ideal to purchase just a few bras to anticipate minute to moderate changes during the entire healing process, explains Dr.
Contrary to popular belief, the goal of breast augmentation procedure is not just about creating a bigger cup size, but more importantly, to deliver results that look and feel natural. Good results from the procedure is only possible in the hands of a qualified plastic surgeon, or to be more specific, a board-certified doctor who regularly performs the surgery and has impressive breast augmentation pictures. All plastic surgeons have before-and-after photos to showcase their artistic skills and also help their future patients make an informed decision, as suggested by Beverly Hills plastic surgery Dr.
A slight lateral bulge is also deemed attractive as it contributes to the hourglass figure, although remember that one’s underlying anatomies also affect the final appearance, says Dr.
You should also look at the distance between the lower edge of the areola and the inframammary fold, which primarily depends on the breast size although for the “average” women it is normally 5-6 cm. Once you are confident with a doctor’s qualifications, you may schedule a consultation with him.
During consultation, ask for the chance to talk to some of your surgeon’s patients who have undergone the procedure.
Methods: Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Earlier diagnosis of breast cancer should be enabled through screening programs to increase treatment effectiveness and to save health care resources.
Universal health insurance coverage should be given more attention, especially since public hospital charges are expected to increase in the near future. The Vietnamese government should have a policy to support cancer patients when the cost of their illness is expected to exceed their ability to pay (with or without health insurance).
A retrospective study was designed to estimate the cost of treatment for women with breast cancer in central Vietnam. Primary data: Patients or their relatives (if patients were deceased) were interviewed directly using a structured questionnaire.
In HCH, between 2001 and 2006, major laboratory tests were often requested to define breast cancer, including breast ultrasound, hematogram, CA 15.3, tumor biopsy, and cytological tests. During the study period, advanced medical equipment and new medications were in limited use in public hospitals in Vietnam. Chemotherapy followed by mastectomy with axillary dissection supplemented with adjuvant chemotherapy. The first, or initial, treatment was implemented after the patient received a positive diagnosis for breast cancer. Costs were divided into three categories: cost of diagnosis, cost of treatment, and cost of follow-up care. Cost of follow-up care included supportive treatment as well as fees for laboratory tests, out-patient visits, and, in some cases, the cost of a dose of tamoxifen. Cost analysis by category: For cost categories, aggregate 5-year cost and annual total cost, the mean, standard deviation, the median and cost range were estimated. According to statistics from the Ministry of Health, user fees accounted for 60–70% of all hospital revenues in 2006, the rest were from the government budget and other sources (21).
More patients with health insurance reported complete or partial compliance than did patients without insurance.
Figure 1 presents estimates of survival probabilities of up to 5 years for patients with breast cancer by stage at diagnosis.
Table 4 displays the cost of the different components of treatment, following the primary diagnosis. The relationship between key characteristics of patients and the total 5-year cost of the course of treatment for breast cancer. As shown in Table 5, further analysis of the relationship between stage at diagnosis and different cost categories revealed that costs increased with stage at diagnosis for the initial treatment period. Data related to government subsidy and other sources included in the estimates of treatment cost for breast cancer at public hospitals are presented in Table 6. The results of this study showed that breast cancer was common among young women in central Vietnam during the study period. The majority of the women in the study population were diagnosed at stage II breast cancer.
The costs presented in the study were adjusted to the year 2010 by the growth in the consumer price index and were annually discounted at 3%.
Because of underestimation of charges in public hospitals, the annual direct medical cost for breast cancer treatment in this study amounted to about 18% of gross national income (GNI) per capita in Vietnam in 2010 ($195 vs. The direct medical costs of a 5-year course of treatment for primary breast cancer in central Vietnam are much lower than in developed countries. Ethical approval for primary and secondary data collection was obtained from the University of Khon Kaen, Thailand (where the study was designed as part of a doctoral study program). Estimation of the financial burden to the national health insurance for patients with major cancers in Taiwan [abstract]. A questionnaire administered in cancer clinics in the province of Ontario, with a mix of urban and rural patients, was analyzed using descriptive statistics and a regression analysis of cross-sectional data. These findings highlight that financial burden for cancer patients can vary by tumour type, and that patients with breast cancer may require a different mix of supportive services than do patients with other common tumour types.
In the Canadian health care setting, cancer patients do not have access to comprehensive cost coverage once care moves outside of the hospital setting.
Furthermore, at least one third of the respondents needed caregiver assistance that required time away from paid work for the caregiver 3.
It is also well documented that costs vary considerably by tumour type, with data from the United States showing variation in mean monthly costs from a low of US$2187 for prostate cancer to a high of US$7616 for pancreatic cancer (2000 dollars) 7. The present article describes secondary outcomes from a survey previously reported by Longo and colleagues 3,4. Our study used a cross-sectional design to elicit data from patients with breast, colorectal, lung, or prostate cancer. The questionnaire was administered to a mix of urban and rural patients in 5 of the 8 cancer clinics in the province of Ontario.
All patients recruited at the outpatient cancer clinic were to be 18 years of age or older and receiving treatment for breast, colorectal, lung, or prostate cancer. Patients were instructed to recall the previous 30 days and to list the costs related to their cancer treatment. Patient demographics, treatment patterns, and categorical costs are captured and presented as means, standard deviations, and ranges. We compared total costs for each tumour type with costs for all other tumour types, but only the comparison of breast cancer costs with costs for all other types showed a statistically significant difference; hence, no analysis of differences for the other primary tumour types was undertaken. The study sample has been extensively described elsewhere; Table I presents a concise version 4.
Of the breast cancer respondents, 50% had been on treatment for more than 6 months; that percentage was 28% in the non-breast-cancer patients.
In a limited number of regression analyses, we found that the differences between tumour types persisted even after controlling for education, income, and age, which are the factors typically cited in the literature as affecting expenditures. Compared with non-breast-cancer patients, patients with breast cancer tended to perceive a greater financial burden. Previous work in this area by CJL 3,4 has shown that patients with a significant or unmanageable burden are more likely to be uninsured and to be under the age of 65. Gaps remain in the understanding of why breast cancer patients have higher expenditures than are seen with other common tumours. Despite the fact that breast cancer patients have a higher average income, they may also be more affected by the loss of income associated with their illness and the resulting impact on their lifestyle. Collecting data for the most recent 30 days increased reliability by limiting recall bias, but it also meant that the resulting data would underestimate costs that tend to be episodic in nature (devices, for example). Another limitation is that a follow-up of respondents was not undertaken; therefore no data are available on the number of patients surveyed just before death. This research was supported by an opportunities grant through the Medicare to Home and Community program, funded through the Canadian Institutes of Health Research, with Dr. Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. Yet many patients have questions regarding the total cost of surgery and if there are options for payment that might put the surgery within reach. The average cost of breast augmentation can actually vary a fair amount from patient to patient and from practice to practice. It should be noted that these financing plans also apply to other procedures, such as breast lift surgery, facial rejuvenation surgery, and body sculpting treatments.
Before you undergo any surgery, we will be sure to discuss all of your aesthetic treatment options as well as what payment options might be right for you. For more information about breast augmentation surgery, breast lift surgery, and your many other options for advanced aesthetic enhancement, be sure to contact our Gatineau cosmetic plastic surgery practice today.
Located in downtown Gatineau, just 10 minutes from the National Capital, the Centre Chirurgical de la Capitale PB is unique in the Outaouais region. Percentage increase in total costs of care among patients receiving at least one tumor marker test relative to those with no tumor marker tests, by time period after diagnosis. Citation: Ramsey SD, Henry NL, Gralow JR, Mirick DK, Barlow W, Etzioni R, Mummy D, Thariani R, Veenstra DL. Breast augmentation, or breast enlargement, uses implants to increase the size of the breasts at the same time that the surgeon reshapes the breast. Breast augmentation surgery generally lasts between 1 and 3 hours and can be conducted on either an inpatient or outpatient basis using either a general or local anesthetic coupled with sedation. Peri-areolar approach, where the incision is made at the juncture between the areola (dark skin around the nipple) and the natural skin.
Regardless of the approach, once the incision is made, the surgeon gently pulls the skin away from the muscle and soft tissue and creates a pocket either in or below the pectoralis major or between the muscle and the breast gland tissue. Scars from breast augmentation surgery are permanent, but are usually placed as inconspicuously as possible. For more information on Breast Augmentation in the Naperville, Oak Brook, Elmhurst IL area call Aesthetic Plastic and Reconstructive Surgery, S.C. To further create a balanced result, it also involves repositioning the nipple area higher on the chest wall. This approach is also suitable for patients who are not satisfied with their current “cup” size. Of course, the final outcome will also depend on the surgeon’s qualifications, specifically his training, skills, board certifications and plastic surgery affiliations, reputation, and experience. A skin-only lift, meanwhile, must be avoided because of its short-lived results, poor healing, and wide scars.
According to a 2014 study published in Plastic and Reconstructive Surgery medical journal, the upper pole to lower pole ratio of 45:55 is the ideal breast shape. Tarick Smaili, a leading breast lift Los Angeles expert, says the 45:55 ratio has always been his basis for design in any type of breast enhancement surgery. This technique favors women with moderately sized breasts that require lifting and narrowing at the same time, says Dr.
While there is always an exception to the rule, “athletic” women have low body fat percentage and little coverage that can predispose them to increased risk of implant rippling and palpability.
The goal is to prevent “too much” augmentation to the point that the patient is forced into a hunched-over running posture, leading to back pain and other physical stress, and poor performance. This is particularly important in athletic women who usually have low body fat percentage and limited soft tissue coverage. Smaili, are filled with a cohesive silicone gel that simulates the feel of the breast tissue. For athletes who usually have insufficient coverage, positioning the device behind the thick layer of muscles can do wonders.


Smaili highlights the importance of using a good-fitting supportive bra, especially when running to prevent the breasts from bouncing independently from the torso. For most patients, the incisions fade into a fine, barely noticeable scar about a year after surgery.
Saline implants, meanwhile, were considered the ideal choice because they were only inflated with saltwater solution once inside the breast pocket.
With this technique, there is no visible scar on the breast skin and the patients enjoy a more natural shape and feel.
But this is only true for women with a defined or deep fold or some slight sagging, which can hide any potential scar.
Meanwhile, these approaches have slight variations to further meet the aesthetic goals of patients. Tarick Smaili says the subglandular, also referred to as “overs” because the implants are over the muscle, tends to provide a more globular look and more fullness in the upper poles of the breast. Smaili says women with little tissue may find themselves with a not-so-natural breast shape with the technique because of the limited amount of coverage.
Smaili recommends the use of silicone breast implants whose filler material has the right amount of cohesiveness that feels like the natural soft tissue.
In fact, some women have been able to return to their “quiet” work just three days postop, although it remains imperative to avoid strenuous activities for at least three weeks. For this reason, women whose jobs require them to move around or carry heavy things may have to wait for another week or two to avoid persistent swelling and other untoward side effects.
Tarick Smaili says avoiding or at least minimizing physical and emotional stress can help the body recover faster from the surgical trauma.
For this reason, the leading Beverly Hills plastic surgeon recommends his patients to buy just a few cotton bras (without underwire) because the breast size and shape will change over the course of their recovery. Meanwhile, there is no recognized certifying board with “cosmetic” or “aesthetic” surgery in its name.
They should appear like a teardrop, with most of the volume in the lower poles while the upper cleavage must look concave rather than globular—unless there is a specific instruction from the patient who wants exaggerated fullness in the area. This will allow you to assess his “principles” and surgical approach that will help you achieve your desired results from breast augmentation procedure; it is equally important that you are comfortable with that provider. The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%). However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance. Advances in screening programs and treatment methods have improved the life expectancy of patients with breast cancer (2).
Medical records of patients with a code of C 50 (ICD-10 version) admitted to Hue Central Hospital (HCH) between 2001 and 2006 were searched to identify breast cancer patients presenting in those years (14). Data on sociodemographic characteristics, the type of initial treatment received during hospitalization as well as during a 5-year follow-up period after the initial treatment, and compliance with the treatment regime for follow-up care were collected. This hospital is located in the city of Hue, the capital of the central coastal Thua Thien Hue province. Some patients might also have had mammography and estrogen receptor (ER) tests, progesterone receptor (PR) tests, and Her 2-Neu tests from other health facilities in the province or in the country (personal communication, Dr. The most common guidelines used in Vietnam for the treatment of breast cancer are reported in Table 1 (personal communication, Dr. External radiotherapy to the breast was also administered and eligible patients received hormone therapy. A range of methods was used, depending on the stage of the breast cancer and the characteristics of the patient. Normally, patients are required to continue with follow-up care after completing an initial treatment so as to detect local recurrence or metastasis. Costs of diagnosis comprised the total cost of laboratory tests that patients received to confirm the diagnosis of breast cancer. With our focus only on breast cancer, we assumed that all patients were administered the same tests on every outpatient visit. Values of median for costs were compared with estimates of median regression in the further cost analysis.
First, key characteristics of the study population, such as stage at diagnosis, health insurance coverage, and age group, were incorporated in a median regression model to determine factors affecting the 5-year total cost for breast cancer. Sensitivity analysis, which added 30–40% to unit costs, presented costs for breast cancer treatment with the government budget supplement. The proportion of patients dropping out of treatment was larger among patients without health insurance than among those with health insurance (26.2% vs. The survival rate was the lowest for late-stage breast cancer, with 43% of patients at stage III and no cases at stage IV surviving as long as 5 years following diagnosis. When these funding sources were included, corresponding mean and median total costs of 5-year treatment and mean and median annual treatment cost were 40% to nearly 70% higher (corresponding to the support of government of 30% and 40%, respectively). During the study period, increases in household income due to economic growth and improvements in diagnostic methods for breast cancer (such as the use of ultrasound) provided opportunities for Vietnamese women to contact health facilities and to have their disease detected at an earlier stage than was likely in the past (13).
Chemotherapy costs made up the highest proportion of the initial treatment-attributable costs. The data were collected over the period 2001 to 2006 and do not reflect current utilization of advanced treatment methods and new medications for breast cancer treatment. The exclusion of government subsidies and other resources lowered the total costs included in our analysis. In addition, approvals for implementing the study at the various study sites were obtained from the Provincial Health Service of Thua Thien Hue province. The research was funded by the Vietnam–Netherland Project at Hue College of Medicine and Pharmacy, Vietnam, and Graduate School of Khon Kaen University, Thailand. Supportive care programs related to financial burden should consider the likelihood and nature of financial burden when counselling breast cancer patients.
Similarly, direct nonmedical costs for home or personal care of cancer patients have not traditionally been funded by the public health care system. In fact, results show that patient-reported financial burden was “problematic” for 20% of the sample population and that loss of time from work for caregivers appeared to substantially influence that burden 3. On average, caregivers provided assistance for a mean of 7 working days of the preceding 30 calendar days 3.
Our survey captured accommodation and meals not under travel costs, but rather as separate entries.
The findings may prove helpful in identifying tumour-specific gaps in existing programs and in informing health care providers of the variable financial needs of cancer patients in the Ontario setting. The study parameters and the design of the questionnaire were described at length in earlier publications 3,4. Additionally, site approvals were obtained from each of the 5 cancer clinics involved in the study. Although all 8 sites were approached, 3 sites did not participate primarily because of human resource constraints or lack of financial support. The 3 non-participating sites included centres in Kingston and Sudbury, and the Princess Margaret Hospital in Toronto. From the results of the pilot study, we determined that, to detect a difference of less than $30, we would require sample sizes beyond the capacity of the participating sites, given the time allotted for the study.
Eligible patients had to have been on active treatment for their cancer for a minimum of 30 days (those on follow-up only were excluded) and had to be able to read and write English or French.
Questions captured information on patient demographics, general health, duration of the current cancer treatment, current treatments being provided (chemotherapy, radiation, surgery, doctor visits, emergency room visits, hospitalizations, in-home nursing services, physiotherapy services), level of insurance coverage, and employment details.
The structure of the questionnaire was built to a significant degree on previous work undertaken with cancer patients in the United States 9,10. Where required, average family income for each participant was taken as the midpoint of the family income category chosen in the questionnaire. This software has the ability to handle weighting of cases and clustering when running standard analyses, including linear or logistic regressions. Other outcomes (demographic and treatment variables) were reported in earlier publications 3,4. Approximately 28% of breast cancer patients reported a mean family income of $80,000 or more, which compares with 10%, 17%, and 16% in the lung, colorectal, and prostate cancer groups respectively. However, the sites are relatively homogeneous, given that they all represent cancer centres with a full suite of cancer care services.
The mean age of the breast, lung, colorectal, and prostate respondents was 52, 64, 63, and 68 years respectively. Tables II and III present 30-day total and categorical costs for the breast cancer and non-breast-cancer populations respectively. Our survey also shows that the likelihood of personal perception of significant or unmanageable financial burden is greater in the breast cancer cohort than in the comparator group. We do note that insurance coverage is a factor: it remained in the final regression model for this analysis as it did in earlier publications. This impact may account for the more frequent reports of significant or unmanageable burden.
The literature suggests that patients tend to underreport their use of health care resources 11,12, and therefore the costs reported here are likely to be a lower bound. Research in the United States has shown that cancer treatment costs are higher in the first 6 months after diagnosis and just before death; costs between those two points in time are lower 14. It is also important to note that indirect costs (lost wages) are not addressed in the present paper but have been shown to be problematic in many cases 3. Because breast cancer patients appear to be more likely to have high expenditures (partly because of their younger age and higher income) it may be appropriate to counsel these patients differently and to offer different supportive services that address their added burden, whether financial or otherwise.
Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care.
The distribution of health care costs and their statistical analysis for economic evaluation.
Medicare payments from diagnosis to death for elderly cancer patients by state at diagnosis.
Using breast implants for enlargement purposes can really work wonders for your figure and your overall body contour. The team at our practice would like to take a few moments to go over some of the basics of these cost concerns right now. During the breast augmentation procedure, breast implants are introduced into the breast pocket in order to enhance size, shape, and overall contour. For that reason there are financing options and payment plans for breast augmentation surgery.
It's important that patients feel happy and confident about all decisions they make regarding surgery, not just the cosmetics of the final results. Our entire team looks forward to meeting you in person and discussing all of your options for advanced cosmetic care in greater detail. Its ultra-modern facilities include two operating rooms equipped with the latest technology. An implant made of a silicone outer shell is inserted into the pocket and centered beneath the nipple.
Your surgeon will likely prescribe antibiotics to avoid infection in addition to any pain medication.
Tarick Smaili warns that a pair of D-cup could weigh in 18 to 23 lbs., enough to force the body to lean forward, increase the risk of injury, and decrease one’s athletic performance.
Saline implants, meanwhile, are firmer because they are only inflated at the time of surgery with [sterile] saltwater solution. As a result, this will minimize the risk of injury, poor posture, and other similar problems. While the result may not appear subtle, he says that some patients nonetheless want this look. The less than optimal results could be further aggravated, he warns, when small-breasted patients choose larger implants.
While this lead to the teardrop shape, which is the quintessence of natural results, rippling at the lower part of the breast might be an issue among thin-skinned patients. For this reason, it is not uncommon for patients to work part-time until their preoperative energy level goes back, a process that can take three to four weeks.
Smaili instructs all his patients to take a short, gentle walk several times a day to promote good circulation of blood. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam.
Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. From a societal perspective, the economic burden of this disease has been reported in several studies using available data in developed countries; however, the direct medical cost is thought to make the smallest contribution to total costs, accounting for 50% of indirect costs (morbidity and mortality) (3, 4). In 2010, it was reported that there were 12,533 women with breast cancer in the country (9).
Data, from medical records and participant's recall, on the patients’ costs for medical care for breast cancer were collected for a period of 5 years following primary diagnosis.
Unit costs for treatments received over the study period were acquired from the hospital's finance department. HCH is one of the three largest hospitals under the management of the Ministry of Health in Vietnam.
Adjuvant radiation was supplemented with either external radiotherapy to the breast, chemotherapy, or both. The most common treatment methods were surgery, radiation therapy, chemotherapy, and hormone therapy, either alone or in combination. Treatment costs included surgery, chemotherapy, radiation therapy, hormone therapy and supportive medication, plus inpatient fees. The compliance of patients with a 5-year period of follow-up care was defined as their conformation to out-patient visits and hormone therapy. In developed countries, the majority of breast cancer patients are postmenopausal, 60–70 years old (1, 10). The analysis was limited to costs of primary breast cancer cases, excluding recurrent cases.
However, the long treatment course significantly influenced out-of-pocket payments by patients without health insurance.
In Ontario, among approximately 12 million residents, an estimated 65,100 new cases of cancer were diagnosed in 2009 1. Based on self-reported financial burden, costs were classified as either “significant” or “unmanageable.” This is not to say that others are not burdened, because another 52% reported that they have “slight” or “somewhat” of a burden (data not shown). We observed that cancer patients who needed caregivers to take time from work were more likely to report a “significant” or “unmanageable” burden than those who did not (34% vs. Briefly, the four cancer types were selected as being the most common (representing 56% of all new cases in Ontario in 2009) 1.
The $30 differential was based on a daily difference of $1, which was felt to be meaningful to patients. Given that the questionnaire was self-administered, no information on disease stage was captured, as the potential responses were felt likely to be unreliable. Stata also has the ability to detect collinearity in multiple regression analysis and omits the offending variables from the final result.
Compared with breast cancer patients at 27%, a higher percentage of the lung, prostate, and colorectal cancer groups reported incomes of less than $40,000 (43%, 40%, and 34% respectively). Among patients meeting the entry criteria, the response rate was high, with 83% agreeing to participate. We do not suggest that other centres operating within community hospitals would have similar expenditures, because those sites were not sampled. Breast cancer patients incurred an additional $225 for imputed travel; non-breast-cancer patients incurred an addition $426 for imputed travel. Furthermore, recent changes in coverage for physiotherapy in Ontario (2005) and the opening of private infusion clinics (2004) are just two examples of how costs borne by patients have expanded since our research was undertaken.
We note that people under the age of 65 are less likely to have comprehensive coverage because many health programs are not covered through the public purse until a person reaches the age of 65, and this factor likely plays an important role.
The observation of higher costs for devices and family care is likely influenced by the fact that women with breast cancer are more likely than are patients with any of the other tumour types to invest in items such as wigs and prostheses.


The data for all tumour types was highly skewed, because a significant number of patients had no costs in many of the categories. An estimated 50% of our breast cancer sample and 29% of our comparator sample had been on treatment for more than 6 months, and thus many of these individuals would be in the relatively low-cost period of their treatment.
Government programs to assist in this regard may also prove useful for those under the age of 65 and those whose private health insurance coverage is limited or insufficient.
By meeting with a skilled plastic surgeon, you can find out how these plastic surgery options can greatly enhance your overall appearance. The type of breast implants used and the location of the incisions will vary based on the aesthetic goals of the patient.
Those who had these tests had 29% higher total medical care costs compared to those not receiving these tests. Bruising and swelling are common following breast augmentation surgery, particularly around the nipple area, and will subside slowly over 3 to 5 weeks. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter.
These medical costs, while a small proportion of overall costs, may overwhelm patients, particularly those with lower incomes. In Vietnam, as in many other developing countries, breast cancer was characterized by late presentation, young patients, and low survival rates (10–13).
Calculation of expenditure for breast cancer treatment was based on actual patient-level cost data, excluding the costs for herbal treatment or unpaid family care, because it is difficult to control these costs, especially in the context of the many variations of herbal medicines in Vietnam. The hospital is a national general hospital and a leading referral hospital in the central region. In this study, only those tests recorded in the patients’ medical records were included. Surgery involved either a complete mastectomy or breast-conserving surgery combined with axillary lymph node dissection.
During follow-up, outpatient appointments were scheduled every 3 months over the first 2 years and every 6 months in subsequent years. Cost of initial treatment was specified as the combination of the cost of diagnosis and the cost of treatment, which was calculated on the basis of data collected from medical records of individual patients. A questionnaire that provided information about compliance with the course of treatment on the basis of repeated outpatient appointments and doses of medication was designed. The cost for surgery was also considerable, at $82.35 per patient regardless of whether the method was a complete mastectomy or breast conservation. The low coverage of health insurance among the study population was reflective of the study period for Vietnam (22). Some patients refused treatment following diagnosis or did not complete their course of treatment. Having health insurance increased patients’ compliance with treatment because the ability to pay played a major role in treatment uptake.
Cancers of the prostate, breast, colon and rectum, and lung and bronchus led the way in numbers of new cases by cancer type in Ontario at 11,200, 8700, 8100, and 7800 respectively 1. A pilot study helped to refine the survey and data-gathering procedures, and to test content and face validity (October–December 2001). A mean income figure for each population group was not possible because the survey presented the question in a categorical manner. Hence, we can expect that an even higher percentage of the population will experience a significant or unmanageable financial burden. The explanation for lower travel and parking costs may be related to the fact that breast cancer patients travel shorter distances on average (45.7 km vs. In many cases, a relatively small population with very high costs influenced the mean—a common occurrence in the health care costing data seen in other published literature 13.
It is important also to note that surgery was likely to have occurred early in the treatment course for the sample population.
A trusted third-party lender will pay for the total cost of the surgery upfront, and the patient will be responsible for repaying the lender on a monthly basis.
Patients may be required to wear a surgical bra for a while to support the breasts during recovery. For each cost category, the mean, standard deviation, median, and cost range were estimated.
Recent studies in Vietnam have revealed that poor knowledge and awareness among the general public is a major contributor to those problems (13). Unit costs during the period of study were provided from the financial department of the hospital. Physical examinations together with laboratory tests, such as hematograms, hepatic ultrasounds, chest X-rays, and CA 15.3, were performed at every out-patient visit. These data were obtained through patient interviews (or interviews with their relatives if the patient was deceased) at the time of the study. The majority of those patients that did not complete their treatment course were those not covered by health insurance (Table 3). The factors that may contribute to high chemotherapy costs are the types of chemotherapy agents used and the cost of supportive care agents (2). Out-of-pocket costs are the main obstacle to medical treatment, especially in case of diseases with a long natural history (such as breast cancer).
The initial treatment, especially chemotherapy, accounted for the largest part of total costs though the range in costs was wide. No significant changes were made after the pilot, and the full survey was initiated after ethics review. Clinics were instructed to accrue equal numbers of patients with each tumour type, with a quota of 12 patients per tumour type, yielding a target sample of 240 patients. Although we considered transforming the costing data, we felt that transformation would reduce the transparency of the results. The mean number of treatment days for breast cancer and non-breast-cancer patients was 424 and 295 respectively, and so patients in our sample would likely have already undergone surgery. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. However, the financial burden of treatment of breast cancer has not yet been considered as a contributing factor. The direct medical cost of treatment for women with breast cancer was analyzed from the perspective of health care payers, including the cost borne by patients and health insurance providers. The time period from 2001 to 2006 was used to obtain a more comprehensive sample of patients at various stages of breast cancer from different age groups.
During this time period, most patients were prescribed tamoxifen daily (personal communication, Dr. At primary diagnosis, the majority of the women had been diagnosed with stage II breast cancer (56.6%). Costs for follow-up care over a 5-year period after primary diagnosis included supportive treatment and other follow-up care as described earlier.
Establishing a policy of universal health insurance coverage in Vietnam would positively impact the current lack of affordable access to appropriate treatment for chronic diseases such as breast cancer. The variety of chemotherapy regimens could explain the wide range of estimated costs for initial treatment as well as the total 5-year treatment course.
Indeed, our study found that a higher number of patients in the group without health insurance coverage dropped out of their treatment regime. Many changes in the socioeconomic structure of Vietnam occurred during the study period and continue to the present.
There is no significant difference in 5-year total cost with regard to age at diagnosis, health insurance coverage, and between early- and late-stage breast cancer patients in the study.
More-sophisticated methods (for example, retransformation or bootstrap methods) could potentially have been used to address the skewness of the data, and we recognize that not undertaking these more sophisticated techniques could be considered a limitation of our analysis. Be sure to discuss all the alternative surgical options with your surgeon to make the best choice for you. The objective of this study is to provide estimates of the total direct medical costs for breast cancer treatment in central Vietnam. The payment amount or hospital fee included the cost of medications and materials used in clinical practice together with the user fees borne by patients. This long time period was necessary because the incidence rate of the disease in Thua Thien Hue province was not high (9).
Different chemotherapy regimes were used, with the most common being FAC (a combination of cyclophosphamide, doxorubicin, and 5-fluorouracil), FEC 120 (cyclophosphamide, epirubicin, and 5-fluorouracil), and a combination of paclitaxel–doxorubicin. Median cost was estimated at $0 for follow-up care in patients at stage IV because 50% of patients at this stage survived less than a year after diagnosis (Figure 1).
Nevertheless, the costs determined by this study were much lower than those reported for developed countries. The regime with paclitaxel–doxorubicin was found to be the most expensive treatment option for chemotherapy over the study period. Universal health insurance coverage is not yet a reality in Vietnam but should be given more attention, especially since public hospital charges are expected to increase in the near future.
These changes in the socioeconomic environment might limit the ability to generalize from these study results. Patients diagnosed with late-stage breast cancer incurred higher costs for initial treatment than those diagnosed at early stages, while their survival time was shorter.
However, strenuous activity and direct stimulation of the breasts are discouraged for up to 4 weeks.
The findings can contribute to models of cost-effectiveness analysis of interventions for breast cancer and can support policy adaptations for better care of the women with this disease in Vietnam.
User fees are based on a decree on partial collection of public hospital fees as regulated by the Vietnamese government (1994) and the decree's revisions (15, 16). In France, for example, the mean medical cost for a 5-year treatment period for breast cancer was $10,744 (23).
Many studies have compared the cost-effectiveness of alternative chemotherapy regimes for the treatment of breast cancer.
The government should have a policy to support cancer patients for whom the cost of illness exceeds their ability to pay or even to co-pay for health insurance.
In addition, precise data were not available for much of the follow-up period for care; these costs were mainly estimated based on the patient's (or relative's) recall of at least 5 years and therefore are subject to potential bias.
Facing these challenges, early detection of breast cancer through screening programs, access to relevant treatment, and an increase in health insurance coverage along with other financial supports to chronic patients should be implemented to improve access to care and the prognosis of breast cancer patients in Vietnam. The main reason for 31 cases being lost to follow-up was migration to another treatment site.
Before treatment began, patients were assessed by laboratory tests based on the proposed approach and regime.
Costs were estimated based on unit cost of tests, outpatient fees, and price of tamoxifen over time.
The annual average cost during the 5 years of treatment was an average of $195 per patient. In addition, if a network of primary health care were to be established throughout the country, alternatives such as home care and community care should be promoted to provide health care services to patients who require long-term care, following an initial hospital stay (such as breast cancer patients). Although efforts were made to enroll a suitable number of cases in the analysis, the low incidence rate of breast cancer in Thua Thien Hue province combined with limitations of medical record preservation before 2008 resulted in a small sample size. In 1996, Legorreta et al., using US medical records and claims data, determined that costs over a 4-year period for patients with stage III breast cancer averaged more than $60,000, whereas costs were lower in patients at stage 0, I, and IV at $19,000, $21,000, and approximately $40,000, respectively (8).
Specialists often requested tests, such as hematograms, chest X-rays, kidney or liver function tests (SGOT, SGPT), CA 15.3, and breast and abdominal ultrasound. For supportive treatment, we used the data collected from medical records during the 5 years after diagnosis (if records were available). According to the experience of the oncologists in HCH (personal communication), the use of expensive chemotherapy regimens depended on the patients’ ability to pay for them. The shift to home care settings may improve the compliance with treatment and reduce out-of-pocket costs for patients in Vietnam, where the access to health facilities for cancer treatment has been limited (33). This affected the opportunity to identify significant differences in cost comparisons among various groups of patients. The choice of tests varied considerably depending on the doctor and the characteristics of each patient. Costs were discounted at an annual rate of 3% as recommended by the World Health Organization (WHO) (18). They reported lower estimates of $602, $356, and $8,530 for Africa, Asia, and North America, respectively (24).
Research on the economic evaluation of different breast cancer chemotherapy regimes should be conducted in the Vietnamese context. The estimated costs for breast cancer treatment might not be representative of other main public hospitals in Hanoi and Ho Chi Minh City or of private hospitals in Vietnam, where unit costs may differ from those in our study (15, 16), thereby limiting the ability to generalize our study findings. For patients on chemotherapy, the initial treatment often lasted for up to 9 months, but the duration was less for patients not on chemotherapy. These costs were then converted to 2010 figures on the basis of the annual inflation index in Vietnam (19).
The result will help health care providers as well as patients in choosing an affordable and effective treatment method.
Despite these limitations, the cost estimates in this article provide the first piece of evidence regarding the cost of breast cancer treatment in Vietnam.
The high proportion of chemotherapy costs is also a reason as to why initial treatment costs were more for patients diagnosed at stage II and higher; chemotherapy is recommended for most of those patients (see Table 1). Comparisons among the wide range of cost estimates for breast cancer treatment and generalizations drawn from economic studies on the disease are made difficult by the different characteristics and patient populations of each country. In fact, the costs of chemotherapy in our study exceeded the total cost of follow-up care over the 5 years after diagnosis ($476.48 vs. They will contribute important information to cost-effectiveness analysis of interventions for breast cancer and will help decision-makers engaged in health system planning and resource allocation.
The diversified unit costs for resource use in different countries could explain the different findings. Because follow-up treatment for breast cancer in the years after the initial treatment was relatively simple, as described in the method section, the related costs were estimated to be small and relatively stable, as was found in other studies (24, 30).
In Vietnam, public hospital charges did not measure the full cost of health care resource usage. For patients diagnosed with stage I breast cancer, the initial treatment costs were very low, but the follow-up care accounted for a higher proportion of the total cost of treatment. Unit costs included the price of medications and materials used in the course of treatment but only a portion of those resources that were subsidized by government policy, such as the hospital facility and clinical staff (15, 16). Sensitivity analysis showed that including the government subsidy increased cost estimates by 40 to 70% (Table 6).
However, even if user fees and government subsidies were combined, hospital charges were still underestimated. Our study revealed that patients diagnosed at a late stage incurred the same costs as those diagnosed at an early stage but had lower survival times. Remuneration of health staff and capital depreciation have not been adequately estimated (26). Early detection of breast cancer may not only increase life expectancy but could also result in resource savings for health care (2, 3). Unit costs in Vietnamese public hospitals and hospital fees are, therefore, lower than the real cost of the resources used.
Presently, a pilot screening program for breast cancer has been introduced in some regions of Vietnam.
In addition, at the time of our study, advanced treatment guidelines were not yet available in Vietnam.



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