Time for equal access to breast reduction surgery in Australia

Women with symptomatic macromastia need relief from a condition that can seriously impair their quality of life

In this issue of the MJA, Crittenden and colleagues report their cost–utility analysis of breast reduction surgery for women with symptomatic breast hypertrophy in Australia.1 Their key finding is that breast reduction surgery is cost‐effective, the cost per quality‐adjusted life‐year (QALY) being considerably lower than the recommended willingness to pay thresholds in the Australian health care system. The authors prospectively assessed health‐related quality of life (SF‐6D utility scores) for 209 women with symptomatic breast hypertrophy before and 12 months after breast reduction surgery. The SF‐6D, a six‐dimensional single health utility score, is derived from the Short Form‐36 (SF‐36), one of the most widely used instruments for assessing health‐related quality of life (range: 0 for death to 1 for perfect health). Their scores were compared with those for 124 women with similar symptoms who had not yet had reduction surgery. The mean SF‐6D scores were similar at baseline, and improved significantly for the women who had undergone surgery (0.313; standard deviation [SD], 0.263 to 0.626; SD, 0.277) but declined slightly (0.296; SD, 0.267 to 0.270; SD, 0.257) for those who had not. The effectiveness of the procedure was measured as the mean differential QALY gain (1.519; 95% confidence interval, 1.362–1.675), obtained at an incremental cost‐effectiveness ratio (ICER) of $7808 per QALY gained.