Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery



+44 (0)20 3312 1947d.leff




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus






BibTex format

author = {Grant, Y and Al-Khudairi, R and St, John E and Barschkett, M and Cunningham, D and Al-Mufti, R and Hogben, K and Thiruchelvam, P and Hadjiminas, DJ and Darzi, A and Carter, AW and Leff, DR},
doi = {10.1002/bjs.11050},
journal = {British Journal of Surgery},
pages = {384--394},
title = {Patient-level costs in margin re-excision for breast-conserving surgery},
url = {},
volume = {106},
year = {2019}

RIS format (EndNote, RefMan)

AB - BackgroundHigh rates of reoperation following breastconserving surgery (BCS) for positive margins are associated with costs to healthcare providers. The aim was to assess the quality of evidence on reported reexcision costs and compare the direct patientlevel costs between patients undergoing successful BCS versus reoperations after BCS.MethodsThe study used data from women who had BCS with or without reoperation at a single institution between April 2015 and March 2016. A systematic review of health economic analysis in BCS was conducted and scored using the Quality of Health Economic Studies (QHES) instrument. Financial data were retrieved using the PatientLevel Information and Costing Systems (PLICS) for patients. Exchange rates used were: US $1 = £0·75, £1 = €1·14 and US $1 = €0·85.ResultsThe median QHES score was 47 (i.q.r. 32·5–79). Only two of nine studies scored in the upper QHES quartile (score at least 75). Costs of initial lumpectomy and reoperation were in the range US $1234–11786 and $655–9136 respectively. Over a 12month interval, 153 patients had definitive BCS and 59 patients underwent reoperation. The median cost of reoperations after BCS (59 patients) was £4511 (range 1752–18 019), representing an additional £2136 per patient compared with BCS without reoperation (P < 0·001).ConclusionThe systematic review demonstrated variation in methodological approach to cost estimates and a paucity of highquality cost estimate studies for reoperations. Extrapolating local PLICS data to a national level suggests that getting BCS right first time could result in substantial savings.
AU - Grant,Y
AU - Al-Khudairi,R
AU - St,John E
AU - Barschkett,M
AU - Cunningham,D
AU - Al-Mufti,R
AU - Hogben,K
AU - Thiruchelvam,P
AU - Hadjiminas,DJ
AU - Darzi,A
AU - Carter,AW
AU - Leff,DR
DO - 10.1002/bjs.11050
EP - 394
PY - 2019///
SN - 1365-2168
SP - 384
TI - Patient-level costs in margin re-excision for breast-conserving surgery
T2 - British Journal of Surgery
UR -
UR -
UR -
UR -
VL - 106
ER -