title: The unwritten price of cosmetic tourism: an observational study and cost analysis.
abstract: OBJECTIVE
  Cosmetic tourism, driven by the promise of inexpensive operations abroad, is increasingly popular despite warnings from professional bodies regarding associated risks. Increasing numbers of individuals have presented to our department requesting NHS treatment of complications from such surgery. We set out to characterize these patients and evaluate costs incurred through their assessment and management.
  
  
  METHODS
  An observational study was conducted from 2007 to 2009 on patients presenting to a tertiary referral Plastic Surgery practice with complications of cosmetic tourism surgery. Demographic characteristics, as well as those related to the operation, were recorded. Hospital patient flow pathways were constructed, cost analysis performed using Patient Level Costing, and expenditure and profitability calculated.
  
  
  RESULTS
  Nineteen patients presented within the study period. Most operations were performed in Europe or Asia, and were primarily breast augmentation procedures (n=13). The principal complications were wound infection or dehiscence, and poor cosmetic results. Eleven patients received NHS treatment, at a cost of £120,841. The mean cost for all patients' management was £6360 (range: £114-£57,968), rising to £10,878 for those accepted for treatment. For 8 of the 9 patients (89%) for whom full patient level costing was available, the hospital incurred a financial loss.
  
  
  CONCLUSIONS
  The costs to the NHS of managing complications of cosmetic tourism are substantial, and underestimated by central funding agencies.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge CB2 2QQ, UK.
authors.forename: K
authors.initials: K
authors.lastname: Miyagi
authors.forename: D
authors.initials: D
authors.lastname: Auberson
authors.forename: A J
authors.initials: AJ
authors.lastname: Patel
authors.forename: C M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D015187:Lipectomy / Q000191:economics / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000191:economics / Q000706:statistics & numerical data; D057193:Medical Tourism / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D057240:Patient Preference; D017060:Patient Satisfaction; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000191:economics / Q000706:statistics & numerical data; D018570:Risk Assessment; D013518:Surgery, Plastic / Q000191:economics* / Q000706:statistics & numerical data*; D006113:United Kingdom