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Cost-effectiveness Analysis Of Implants Versus Autologous Perforator Flaps Using The Breast-Q
Evan Matros, MD, MMSc1, Claudia Albornoz, MD, MPH2, Shantanu Razdan, MD, MPH1, Babak Mehrara, MD1, Sheina Macadam, MD3, Teresa Ro, BS2, Joe J. Disa, MD1, Colleen McCarthy, MD, MPH1, Peter G. Cordeiro, MD1, Andrea Pusic, MD, MPH1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3University of British Columbia, Vancouver, BC, Canada.

Purpose: Reimbursement has been recognized as a physician barrier to autologous reconstruction. Autologous are more expensive than prosthetic reconstructions, but provide greater health-related quality of life(HR-QOL). Existing cost-effectiveness (CE) analyses have not included patient input in the effectiveness evaluation. The hypothesis is that autologous tissue reconstructions are cost-effective compared to prosthetic techniques when considering HR-QOL and patient satisfaction.
Methods: A CE analysis from the payer perspective including patient input was performed for unilateral and bilateral reconstructions with DIEPs and implants. The effectiveness measure was derived using the BREAST-Q© and interpreted as the cost for obtaining 1 year of perfect breast-related health (breast-QALYs). Costs were obtained from the Nationwide Inpatient Sample 2010. The incremental cost-effectiveness ratio (ICER) was generated. A sensitivity analysis for age and stage at diagnosis was performed.
Results: BREAST-Q© scores from 309 patients with implants and 217 DIEPs reconstructions were included. The additional cost for obtaining 1 year of perfect breast-related health for a unilateral DIEP flap compared to implant reconstruction was \,941. For bilateral DIEPs compared to implant reconstructions, the cost for an additional breast-QALY was \,017. The sensitivity analysis demonstrated that the cost for an additional breast-QALY for DIEPs compared to implants was less for younger patients and those with earlier stage breast cancer.
Conclusions: DIEPs are cost-effective compared to implants especially for unilateral reconstructions. CE of autologous techniques is maximized in women with longer life expectancy. Patient reported outcome findings can be incorporated into CE analyses to demonstrate the relative value of reconstructive procedures.


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