title: Cost-effectiveness analysis of implants versus autologous perforator flaps using the BREAST-Q.
abstract: BACKGROUND
  Reimbursement has been recognized as a physician barrier to autologous reconstruction. Autologous reconstructions are more expensive than prosthetic reconstructions, but provide greater health-related quality of life. The authors' hypothesis is that autologous tissue reconstructions are cost-effective compared with prosthetic techniques when considering health-related quality of life and patient satisfaction.
  
  
  METHODS
  A cost-effectiveness analysis from the payer perspective, including patient input, was performed for unilateral and bilateral reconstructions with deep inferior epigastric perforator (DIEP) flaps and implants. The effectiveness measure was derived using the BREAST-Q and interpreted as the cost for obtaining 1 year of perfect breast health-related quality-adjusted life-year. Costs were obtained from the 2010 Nationwide Inpatient Sample. The incremental cost-effectiveness ratio was generated. A sensitivity analysis for age and stage at diagnosis was performed.
  
  
  RESULTS
  BREAST-Q scores from 309 patients with implants and 217 DIEP flap reconstructions were included. The additional cost for obtaining 1 year of perfect breast-related health for a unilateral DIEP flap compared with implant reconstruction was $11,941. For bilateral DIEP flaps compared with implant reconstructions, the cost for an additional breast health-related quality-adjusted life-year was $28,017. The sensitivity analysis demonstrated that the cost for an additional breast health-related quality-adjusted life-year for DIEP flaps compared with implants was less for younger patients and earlier stage breast cancer.
  
  
  CONCLUSIONS
  DIEP flaps are cost-effective compared with implants, especially for unilateral reconstructions. Cost-effectiveness of autologous techniques is maximized in women with longer life expectancy. Patient-reported outcomes findings can be incorporated into cost-effectiveness analyses to demonstrate the relative value of reconstructive procedures.
authors.affiliation: New York, N.Y.; and Vancouver, British Columbia, Canada From the Plastic and Reconstructive Surgical Service, Memorial Sloan Kettering Cancer Center; and the Department of Surgery, University of British Columbia.
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.forename: Shantanu N
authors.initials: SN
authors.lastname: Razdan
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.forename: Sheina A
authors.initials: SA
authors.lastname: Macadam
authors.forename: Teresa
authors.initials: T
authors.lastname: Ro
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018427:Breast Implants / Q000191:economics*; D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000191:economics* / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D061525:Perforator Flap / Q000191:economics*; D011788:Quality of Life; D055815:Young Adult