Cost-effectiveness Analysis of Abdominal-based Autogenous Tissue and Tissue-expander Implant following Mastectomy

Abstract

Background: Patients who had undergone both autologous abdominal tissue (AAT) and tissue expander and implant (TE/I) breast reconstruction reported satisfaction with their reconstruction. While aesthetics and quality of life are important, the cost associated with these procedures must also be considered when choosing one method over the other. The objective of this study was to determine whether AAT-based breast reconstruction is cost-effective compared with 2-stage TE/I reconstruction at a 12-month follow-up.

Methods: Thirty-five patients consented and complied to participate in the study with a follow-up of 12 months. The effectiveness of both AAT and TE/I was measured using the Health Utilities Index Mark 3 (HUI-3). From the HUI-3 results, quality-adjusted life years were calculated for each reconstructive approach. Direct healthcare and productivity costs were captured from surgeon billing codes, patient files, and patient diaries. The perspectives of both the Ministry of Health and of society were considered.

Results: From the perspectives of both the Ministry of Health and of society, AAT was less effective and more costly when compared with TE/I.

Conclusions: In this economic evaluation, TE/I dominated AAT, in that TE/I was more effective and less costly as compared with AAT from the perspectives of both the Ministry of Health and of society at 12 months of follow-up. This conclusion should be interpreted with caution due to a small sample size, the short timespan of the study, and the nonrandomized study design.

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. This project was supported by the McMaster Surgical Associates (MSA) from McMaster University, ON, Canada.

Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

Figures

Fig. 1.

Societal and the Ministry of Health costs defined.

Fig. 2.

Illustrative cost-effectiveness plane.

Fig. 3.

Cost-effectiveness acceptability curves for societal and Ministry of Health (MOH) perspectives. Cost-effectiveness acceptability curves for TE/I breast reconstruction across 2 perspectives. Cost-effectiveness acceptability curves were based on 1000 bootstrap cost–effect pairs. Yellow line represents the MOH perspective; blue line represents the societal perspective. At the willingness-to-pay threshold of $50,000/QALY, there is >90% probability that the TE/I is cost-effective.

Fig. 4.

Data on recruitment and retention of participants. n, number of patients.

Fig. 5.

Cost-effectiveness plane data. Cost-effectiveness probabilistic analysis results, based on 1000 bootstrapped cost-effect pairs: societal perspective is shown in blue; and Ministry of Health (MOH) perspective is shown in orange. Location of each dot is determined by incremental cost and incremental quality-adjusted life year between AAT and TE/T as a result of each simulation. As most of the dots fall in the left upper quadrant, that is, “lose–lose” quadrant of the cost-effectiveness plane, this means that AAT breast reconstructive approach is more costly and less effective.