An international comparison of reimbursement for DIEAP flap breast reconstruction.
BACKGROUND
The deep inferior epigastric artery perforator (DIEAP) flap is currently considered the gold standard for autologous breast reconstruction. With the current economic climate and health cutbacks, we decided to survey reimbursement for DIEAP flaps performed at the main international centres in order to assess whether they are funded consistently.


METHODS
Data were collected confidentially from the main international centres by an anonymous questionnaire.


RESULTS
Our results illustrate the wide disparity in international DIEAP flap breast reconstruction reimbursement: a unilateral DIEAP flap performed in New York, USA, attracts €20,759, whereas the same operation in Madrid, Spain, will only be reimbursed for €300. Only 35.7% of the surgeons can set up their own fee. Moreover, 85.7% of the participants estimated that the current fees are insufficient, and most of them feel that we are evolving towards an even lower reimbursement rate. In 55.8% of the countries represented, there is no DIEAP-specific coding; in comparison, 74.4% of the represented countries have a specific coding for transverse rectus abdominis (TRAM) flaps. Finally, despite the fact that DIEAP flaps have become the gold standard for breast reconstruction, they comprise only a small percentage of all the total number of breast reconstruction procedures performed (7-15%), with the only exception being Belgium (40%).


CONCLUSIONS
Our results demonstrate that DIEAP flap breast reconstruction is inconsistently funded. Unfortunately though, it appears that the current reimbursement offered by many countries may dissuade institutions and surgeons from offering this procedure. However, substantial evidence exists supporting the cost-effectiveness of perforator flaps for breast reconstruction, and, in our opinion, the long-term clinical benefits for our patients are so important that this investment of time and money is absolutely essential.
Department of Plastic and Reconstructive Surgery, Cambridge University Hospital, Cambridge, UK.
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Reid
Department of Plastic Surgery, University Hospital Gent, De Pintelaan 185, 2K12C, B-9000 Gent, Belgium.
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Szpalski
Department of Plastic and Reconstructive Surgery, Cambridge University Hospital, Cambridge, UK.
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Sheppard
Department of Plastic Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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Morrison
Department of Plastic Surgery, University Hospital Gent, De Pintelaan 185, 2K12C, B-9000 Gent, Belgium. Electronic address: phillip.blondeel@ugent.be.
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Blondeel
D003365:Costs and Cost Analysis; D019074:Epigastric Arteries / Q000601:surgery*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D016462:Mammaplasty / Q000191:economics* / Q000379:methods; D061525:Perforator Flap / Q000098:blood supply* / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics*; D011795:Surveys and Questionnaires
Autologous breast reconstruction; Breast reconstruction; DIEAP flap; Health insurance; Perforator flap; Reimbursement