Cost-effectiveness analysis for computer-aided surgical simulation in complex cranio-maxillofacial surgery.
OBJECTIVE
The purpose of this study is to assess the costs and benefits of computer-aided surgical simulation (CASS) and to compare it with the current surgical planning methods for complex cranio-maxillofacial (CMF) surgery.


METHODS
The comparison of methods applies to all CMF surgeries where the patient's condition is severe enough to undergo a computed tomography scan and a stereolithographic model is necessary for the surgical planning process. The costs for each method can be divided into time and other costs. The time was estimated based on the authors' experience as well as on a survey of a small group of 6 experienced CMF surgeons in the United States. The other costs were estimated based on the authors' experience.


RESULTS
CASS has lower costs in terms of surgeon time, patient time, and material costs. Specifically, total surgeon hours spent in planning are 5.25 hours compared with 9.75 for current standard methods. Material and scanning costs are Dollars 1,900 for CASS compared with about Dollars 3,510 for standard methods. Patient time for planning is reduced from 4.75 hours to 2.25 hours with CASS. The reduction in both time and other costs remains when the fixed fee costs of CASS are added to the variable costs. Amortized across the 600 patients per year (1,800 for the assumed 3-year life of the training and software), this adds only a few dollars and a fraction of an hour per surgery. Even in the case of a small clinic when the cost is amortized for 6 patients per year (18 patients for the assumed 3-year life of the training and software), the per surgery costs (9.65 hours and Dollars 2,456) will still favor CASS.


CONCLUSIONS
Any great new design should consist of at least 2 of the 3 following features: faster, cheaper, and better outcome. This analysis demonstrates that CASS is faster and less costly than the current standard planning methods for complex CMF surgery. Previous studies have also shown that CASS results in better surgical outcomes. Thus, in all regards, CASS appears to be at least as good as the current methods of surgical planning.
Xia
James J
JJ
Surgical Planning Laboratory, Department of Oral and Maxillofacial Surgery, The Methodist Hospital Research Institute, Houston, TX, USA. Jxia@tmh.tmc.edu
Phillips
Carl V
CV
Gateno
Jaime
J
Teichgraeber
John F
JF
Christensen
Andrew M
AM
Gliddon
Michael J
MJ
Lemoine
Jeremy J
JJ
Liebschner
Michael A K
MA
D003198:Computer Simulation / Q000191:economics*; D003362:Cost-Benefit Analysis; D019465:Craniofacial Abnormalities / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D008953:Models, Anatomic; D010347:Patient Care Planning / Q000191:economics*; D012886:Skull / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000191:economics*; D013997:Time Factors