A cost-effectiveness analysis of delayed breast reconstruction with pedicled flaps from the back

Ahmad Makki*, Jørn B. Thomsen, Gudjon L. Gunnarsson, Lisbet R. Hölmich, Professor Jens A. Sørensen, Mikkel B. Rindom

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Variability in breast reconstruction methods provides an opportunity to investigate whether a method is superior to another with regard to cost, quality, or both. We performed a cost-effectiveness analysis (CEA) study based on tertiary endpoint data from a randomized clinical trial to compare the cost-effectiveness of delayed breast reconstruction by either a latissimus dorsi flap (LD) or a thoracodorsal artery perforator flap (TAP). Material & methods: A total of 50 women were included for unilateral delayed breast reconstruction and were randomized to reconstruction by either the LD flap (n = 18) or the TAP flap (n = 22). The CEA was based on differences in shoulder function after the reconstruction. Direct and indirect costs relating to the two procedures were assessed by the Danish Diagnosis-Related Groups tariffs. Results: Our analysis showed a significant positive effect of introducing the TAP flap on the total shoulder score with an additional cost of $2779. The incremental cost-effectiveness ratio was $4481 and based on a willingness to pay (WTP) $500, we found an estimated net benefit of $519, which was statistically significant (p = 0.0375). The cost-effectiveness acceptability curve indicated that there is a 96.3% probability for the TAP flap being cost-effective to the LD flap at a WTP threshold of $500. Conclusion: From a societal perspective, our cost-effective analysis demonstrated that the TAP flap is the more cost-effective method of breast reconstruction compared to the LD flap with respect to patient-reported shoulder-related disability.

Original languageEnglish
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
ISSN1748-6815
DOIs
Publication statusE-pub ahead of print - 25. Feb 2022

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Ltd

Keywords

  • Breast reconstruction
  • Constant shoulder score
  • Cost-effectiveness
  • Cost-effectiveness analysis
  • Latissimus dorsi flap
  • Myocutaneous flaps
  • Perforator flaps
  • Thoracodorsal artery perforator flap

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