title: Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.
abstract: BACKGROUND
  We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction.
  
  
  METHODS
  Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables.
  
  
  RESULTS
  Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771.
  
  
  CONCLUSIONS
  The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries.
authors.affiliation: Nightingale Centre and Genesis Breast Cancer Prevention Centre, University Hospital South Manchester, Wythenshawe, M23 9LT Manchester, UK. richard.johnson@uhsm.nhs.uk
authors.forename: R K
authors.initials: RK
authors.lastname: Johnson
authors.forename: C K
authors.initials: CK
authors.lastname: Wright
authors.forename: A
authors.initials: A
authors.lastname: Gandhi
authors.forename: M C
authors.initials: MC
authors.lastname: Charny
authors.forename: L
authors.initials: L
authors.lastname: Barr
mesh_terms: D062088:Acellular Dermis / Q000191:economics* / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000191:economics / Q000627:therapeutic use; D003094:Collagen / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D016462:Mammaplasty / Q000191:economics* / Q000379:methods*; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D061646:Operative Time; D006113:United Kingdom
chemical_list: D001672:Biocompatible Materials; C568444:strattice; D003094:Collagen