title: The cost effectiveness of acellular dermal matrix in expander-implant immediate breast reconstruction.
abstract: BACKGROUND
  Expander-implant breast reconstruction is often supplemented with acellular dermal matrix (ADM). The use of acellular dermal matrix has allowed for faster, less painful expansions and improved aesthetics, but with increased cost. Our goal was to provide the first cost utility analysis of using acellular dermal matrix in two-stage, expander-implant immediate breast reconstruction following mastectomy.
  
  
  METHODS
  A comprehensive literature review was conducted to identify complication rates for two-stage, expander-implant immediate breast reconstruction with and without acellular dermal matrix. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes and expert utility estimates to fit into a decision model. The decision model evaluated the cost effectiveness of acellular dermal matrix relative to reconstructions without it. Retail costs for ADM were derived from the LifeCell 2012 company catalogue for Alloderm.
  
  
  RESULTS
  The overall complication rates were 30% and 34.5% with and without ADM. The decision model revealed a baseline cost increase of $361.96 when acellular dermal matrix is used. The increase in Quality-Adjusted Life Years (QALYs) is 1.37 in the population with acellular dermal matrix. This yields a cost effective incremental cost-utility ratio (ICUR) of $264.20/QALY. Univariate sensitivity analysis confirmed that using acellular dermal matrix is cost effective even when using retail costs for unilateral and bilateral reconstructions.
  
  
  CONCLUSIONS
  Our study shows that, despite an increased cost, acellular dermal matrix is a cost effective technology for patients undergoing two-stage, expander-implant immediate breast reconstruction due to its increased utility in successful procedures.
authors: Geisel School of Medicine at Dartmouth, Hanover, NH, USA. Electronic address: Naveen.Krishnan07@gmail.com.
authors: Naveen M
authors: NM
authors: Krishnan
authors: Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors: Abhishek
authors: A
authors: Chatterjee
authors: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors: Kari M
authors: KM
authors: Rosenkranz
authors: Tuck School of Business at Dartmouth, Hanover, NH, USA.
authors: Stephen G
authors: SG
authors: Powell
authors: Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors: John F
authors: JF
authors: Nigriny
authors: Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors: Dale C
authors: DC
authors: Vidal
mesh_terms: D062088:Acellular Dermis; D019928:Breast Implantation / Q000191:economics* / Q000379:methods; D018427:Breast Implants / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D015626:Tissue Expansion / Q000191:economics* / Q000379:methods
keywords: Acellular dermal matrix; Cost effectiveness analysis