title: Cost-utility analysis comparing free and pedicled TRAM flap for breast reconstruction.
abstract: The purpose of this study was to compare the free TRAM to the unipedicled TRAM flap in postmastectomy reconstruction, using a cost-utility analysis. A decision analytic model was used for this study. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits (1998). Hospital costs were obtained from St. Joseph's Healthcare, a university hospital in Hamilton, Ontario. Utilities were obtained from 33 "experts" across Canada and then converted into quality-adjusted life-years (QALYs). The probabilities of various health states associated with unipedicled and free TRAM flaps were obtained by reviewing several key articles. The free TRAM flap was more costly than the unipedicled TRAM flap, but it provided more QALYs. The baseline incremental cost-utility ratio (ICUR) was $5,113.73/QALY, favoring adoption of the free TRAM flap. This study showed that the free TRAM flap is a cost-effective procedure for postmastectomy reconstruction in the Canadian healthcare system.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, St. Joseph's Healthcare, Surgical Outcomes Research Centre and McMaster University, Hamilton, Ontario, Canada. athoma@mcmaster.ca
authors.forename: Achilleas
authors.initials: A
authors.lastname: Thoma
authors.forename: Dana
authors.initials: D
authors.lastname: Khuthaila
authors.forename: Gloria
authors.initials: G
authors.lastname: Rockwell
authors.forename: Karen
authors.initials: K
authors.lastname: Veltri
mesh_terms: D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D009313:National Health Programs / Q000191:economics; D009864:Ontario; D019057:Quality-Adjusted Life Years; D013524:Surgical Flaps / Q000191:economics