Assessing value in breast reconstruction - a systematic review of cost-effectiveness studies

Publication date: Available online 9 October 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Clifford C. Sheckter, Evan Matros, Arash Momeni
IntroductionBreast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high value care models.MethodsA systematic review of PubMed, Web of Science, and the Cost-Effectiveness Analysis Registry was conducted. Two reviewers independently evaluated all publications up until December 12, 2016.ResultsAfter removal of duplicates, 1910 records were screened, from which 53 studies underwent full text review. The 13 studies included for final analysis all included an incremental cost-effectiveness ratio (ICER). Five studies evaluated the cost-effectiveness of technology including: acellular dermal matrix (ADM) in staged prosthetic reconstruction, ADM in direct-to-implant (DTI) reconstruction, preoperative computed tomography angiography (CTA) in autologous reconstruction, indocyanine green dye angiography in evaluating anastomotic patency, and abdominal mesh reinforcement in abdominal tissue transfer. The remaining eight studies evaluated the cost-effectiveness of different reconstruction methods. Cost-effective strategies included: free vs. pedicled abdominal tissue transfer, DTI vs. staged prosthetic reconstruction, and fascia-sparing variants of free abdominal tissue transfer.ConclusionsCurrent evidence demonstrates multiple cost-effective technologies and methods in accomplishing successful breast reconstruction. Plastic surgeons should be well informed of such economic models when engaging payers and policy makers in discussions regarding high value breast reconstruction.