title: Resource implications of bilateral autologous breast reconstruction--a single centre's seven year experience.
abstract: OBJECTIVE
  Since the recent introduction of ''Payment by Results'' as part of NHS financial reforms, it has been noted that there is an imbalance between allocated Healthcare Resource Group tariffs and actual resource use for certain procedures. This study was undertaken to assess the impression that bilateral breast reconstruction using autologous flaps is under-funded.
  
  
  METHODS
  Patients who underwent bilateral flap breast reconstruction following mastectomy between 2000 and 2006 at Addenbrooke's University Hospital were identified. Resource cost analysis for each patient was based on the following parameters: number of operating consultants, theatre running costs, and length of hospital stay. The estimated hospital costs were then compared to the national tariff for the Healthcare Resource Group ''Complex Breast Reconstruction using Flaps''.
  
  
  RESULTS
  Over the 7-year period 24 patients underwent bilateral flap breast reconstruction (7 paired latissimus dorsi and 17 paired abdominal flaps). The mean operative time was 9.4h (£4.5/min), the mean hospital stay was 10 days (£150/day) and ten patients required 2 consultants (£34/h) operating. The average total cost equated to £5 492.
  
  
  CONCLUSIONS
  The allocated tariff of £4 053 is insufficient, even before the inclusion of hidden costs. Bilateral free flap breast reconstructions are grossly under-funded at present. With increasing financial pressures on NHS Trusts there may be a drive towards simpler operations, which receive proportionally greater remuneration.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge CB2 2QQ, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Molina
authors.forename: A
authors.initials: A
authors.lastname: Ponniah
authors.forename: J
authors.initials: J
authors.lastname: Simcock
authors.forename: M S
authors.initials: MS
authors.lastname: Irwin
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics*; D013524:Surgical Flaps; D014182:Transplantation, Autologous / Q000191:economics*; D016896:Treatment Outcome; D006113:United Kingdom