A Cost-Utility Analysis Comparing the Sartorius versus the Rectus Femoris Flap in the Treatment of the Infected Vascular Groin Graft Wound.
BACKGROUND
The purpose of this study was to examine the sartorius and rectus femoris flaps as reasonable coverage options for the infected vascular groin graft wound. The authors' goal was to perform a cost-utility analysis of the sartorius flap versus the rectus femoris flap in the treatment of an infected vascular groin graft.


METHODS
Cost-utility methodology involved a literature review compiling outcomes for specific flap interventions, obtaining utility scores for complications to estimate quality-adjusted life-years, accruing costs using Diagnosis-Related Group and Current Procedural Terminology codes for each intervention, and developing a decision tree that could portray the more cost-effective strategy. The authors also performed sensitivity analysis to check the robustness of their data. Szilyagi III and Samson III and IV grades of infected groin grafts were included in the study.


RESULTS
Twenty-six studies were used pooling 296 patients (234 sartorius flaps and 62 rectus flaps). Decision tree analysis noted that the rectus femoris flap was the more cost-effective option. It was the dominant treatment option given that it was more clinically effective by an additional 0.30 quality- adjusted life-years, with the sartorius flap option costing an additional $2241.88. The sartorius flap had a 13.68 percent major complication rate versus an 8.6 percent major complication rate for the rectus femoris flap. One-way sensitivity analysis showed that the sartorius flap became a cost-effective option if its major complication rate was less than or equal to 8.89 percent.


CONCLUSIONS
The rectus femoris flap in the treatment of the infected vascular groin graft is a cost-effective option compared with the sartorius flap.
Philadelphia, Pa.; Miami, Fla.; Lebanon, N.H.; and South Portland, Me. From the Department of Surgery, University of Pennsylvania; Miami Breast Center; the Department of Surgery, Dartmouth Hitchcock Medical Center; and Plastic and Hand Associates of Portland, Maine.
Abhishek
A
Chatterjee
Tomasz
T
Kosowski
Bryan
B
Pyfer
Carla S
CS
Fisher
Julia C
JC
Tchou
Sirish
S
Maddali
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006119:Groin / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D052097:Quadriceps Muscle / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D018570:Risk Assessment; D013524:Surgical Flaps / Q000009:adverse effects / Q000145:classification* / Q000191:economics*; D013530:Surgical Wound Infection / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014481:United States; D014945:Wound Healing / Q000502:physiology*