A Cost-utility Analysis Of The Use Of Preoperative Computed Tomographic-angiography In Abdomen-based Perforator Flap Breast Reconstruction
ANAEZE C. OFFODILE, Jr., MD1, ABHISHEK CHATTERJEE, MD, MBA2, SERGIO VALLEJO, MD1, CARLA FISHER, MD2, JULIA C. TCHOU, MD, PhD2, LIFEI GUO, MD, PHD, FACS1.
1LAHEY HOSPITAL AND MEDICAL CENTER, BURLINGTON, MA, USA, 2UNIVERSITY OF PENNSYLVANIA, PHILADELPHIA, PA, USA.
Purpose: Computed tomographic (CT)-angiography is a diagnostic tool increasingly used for preoperative vascular mapping in abdomen-based perforator flap breast reconstruction. This study compared the use of CT-angiography and the conventional practice of Doppler ultrasonography only in post mastectomy reconstruction using a cost-utility model.
Methods: Following a comprehensive literature review, a decision analytic model was created using the three most clinically relevant health outcomes in free autologous breast reconstruction with CT-angiography versus Doppler ultrasonography only. Cost and utility estimates for each health outcome were used to derive the quality adjusted life years (QALY) and incremental cost utility ratio (ICUR). One-way sensitivity analysis was performed to scrutinize the robustness of our results.
Results: Six studies and 782 patients were identified. Cost-utility analysis revealed a baseline cost savings of \,179, a gain in QALY of 0.25. This yielded an ICUR of -\,716 implying a dominant choice favoring pre-operative CT-angiography. Sensitivity analysis revealed that CT-angiography was costlier when the operative time difference between the two techniques was less than 21.3 minutes. However, the clinical advantage of CT angiography over Doppler ultrasonography only showed that CT angiography would still remain the cost effective option even if it offered no additional operating time advantage.
Conclusion: Our results show that CT-angiography is a cost effective technology for identifying lower abdominal perforators for autologous breast reconstruction. While the perfect study would be a randomized controlled trial of the two approaches with true cost accrual, our results represent the best available evidence.
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