title: [A cost analysis of DIEP flap in breast reconstruction].
abstract: BACKGROUND
  We postulate that the absence of a CPT code for DIEP (deep inferior epigastric perforator) free flap in breast reconstruction is in part responsible for the delayed adoption of this modern technique in France. In order to provide data to our regulating health agency, we determined the cost of this technique compared to a gold standard. We performed a cost-identification study, comparing costs of DIEP free flap versus latissimus dorsi pedicled flap with implant (LD+I) in secondary breast reconstruction following irradiation.
  
  
  METHODS
  Over a 12-month period, direct medical and non-medical costs as well as indirect costs were recorded in both groups (DIEP and LD+I).
  
  
  RESULTS
  In an academic department funded by the national health system, total cost of a secondary breast reconstruction by DIEP free flap was 10,671 ± 3005€ (n=57) versus 8218 ± 2049€ (n=18) for the LD+I group (P<0.05). Mean OR occupation time was 390 ± 64minutes for DIEP versus 283 ± 44minutes for LD+I (P<0.05). Mean hospital stay was 6 ± 2 days for DIEP versus 5 ± 2 days for LD+I (P>0.05).
  
  
  CONCLUSIONS
  DIEP free flap technique offers a long lasting breast reconstruction at an reasonable expense compared to the LD+I (+22%). Furthermore, in an academic department, collaboration of two microsurgeons during DIEP flaps allows OR times to drop significantly and become competitive with LD+I.
authors.affiliation: Service de chirurgie plastique réparatrice et esthétique, hôpital Henri-Mondor, Créteil, France. alexandremarchac@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Marchac
authors.forename: R
authors.initials: R
authors.lastname: Bosc
authors.forename: M-D
authors.initials: MD
authors.lastname: Benjoar
authors.forename: M
authors.initials: M
authors.lastname: Hivelin
authors.forename: C
authors.initials: C
authors.lastname: Lepage
authors.forename: L
authors.initials: L
authors.lastname: Lantieri
mesh_terms: D000009:Abdominal Muscles; D003362:Cost-Benefit Analysis; D039702:Current Procedural Terminology; D019074:Epigastric Arteries; D005260:Female; D005602:France; D058752:Free Tissue Flaps / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D008408:Mastectomy / Q000191:economics; D017568:Rectus Abdominis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome