title: Autologous bone flap versus hydroxyapatite prosthesis in first intention in secondary cranioplasty after decompressive craniectomy: a French medico-economical study.
abstract: OBJECTIVE
  Decompressive craniectomy is the most common justification for cranioplasty. A medico-economial study based on the effective cost of the hydroxyapatite prosthesis, the percentage of autologous bone graft's loss due to bacterial contamination and the healthcare reimbursment, will allow us to define the best strategy in term of Healthcare economy management for the cranioplasties. A comparison was made between the two groups of patients, autologous bone flap versus custom-made prosthesis in first intention, based on the clinical experience of our department of neurosurgery.
  
  
  RESULTS
  No differences was shown between the two groups of patients, in terms of lenght of in-hospital stay and population's characteristics or medical codification. The mean cost of a cranioplasty using the autologous bone graft in first intention was €4045, while the use of hydroxyapatite prosthesis led to a cost of €8000 per cranioplasty.
  
  
  CONCLUSIONS
  In term of Healthcare expenses, autologous bone flap should be used in first intention for cranioplasties, unless the flap is contaminated or in specific indications, when the 3D custom-made hydroxyapatite prosthesis should be privilegied.
authors: Department of neurosurgery, LUNAM university, university hospital of Angers, 4, rue Larrey, 49933, Angers cedex 9, France. lemee.jmichel@wanadoo.fr
authors: J-M
authors: JM
authors: Lemée
authors: D
authors: D
authors: Petit
authors: M
authors: M
authors: Splingard
authors: P
authors: P
authors: Menei
mesh_terms: D016025:Bone Transplantation / Q000191:economics*; D056424:Decompressive Craniectomy / Q000191:economics* / Q000379:methods; D017886:Durapatite / Q000191:economics* / Q000627:therapeutic use; D005602:France; D006801:Humans; D033182:Intention; D019736:Prostheses and Implants / Q000191:economics*; D019651:Plastic Surgery Procedures / Q000191:economics; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps / Q000473:pathology; D014182:Transplantation, Autologous / Q000191:economics
chemical_list: D017886:Durapatite