title: Is There a Difference in Cost Between Standard and Virtual Surgical Planning for Orthognathic Surgery?
abstract: OBJECTIVE
  Virtual surgical planning (VSP) and 3-dimensional printing of surgical splints are becoming the standard of care for orthognathic surgery, but costs have not been thoroughly evaluated. The purpose of this study was to compare the cost of VSP and 3-dimensional printing of splints ("VSP") versus that of 2-dimensional cephalometric evaluation, model surgery, and manual splint fabrication ("standard planning").
  
  
  METHODS
  This is a retrospective cohort study including patients planned for bimaxillary surgery from January 2014 to January 2015 at Massachusetts General Hospital. Patients were divided into 3 groups by case type: symmetric, nonsegmental (group 1); asymmetric (group 2); and segmental (group 3). All cases underwent both VSP and standard planning with times for all activities recorded. The primary and secondary predictor variables were method of treatment planning and case type, respectively. Time-driven activity-based micro-costing analysis was used to quantify the differences in cost. Results were analyzed using a paired t test and analysis of variance.
  
  
  RESULTS
  The sample included 43 patients (19 in group 1, 17 in group 2, and 7 in group 3). The average times and costs were 194 ± 14.1 minutes and $2,765.94, respectively, for VSP and 540.9 ± 99.5 minutes and $3,519.18, respectively, for standard planning. For the symmetric, nonsegmental group, the average times and costs were 188 ± 17.8 minutes and $2,700.52, respectively, for VSP and 524.4 ± 86.1 minutes and $3,380.17, respectively, for standard planning. For the asymmetric group, the average times and costs were 187.4 ± 10.9 minutes and $2,713.69, respectively, for VSP and 556.1 ± 94.1 minutes and $3,640.00, respectively, for standard planning. For the segmental group, the average times and costs were 208.8 ± 13.5 minutes and $2,883.62, respectively, for VSP and 542.3 ± 118.4 minutes and $3,537.37, respectively, for standard planning. All time and cost differences were statistically significant (P < .001).
  
  
  CONCLUSIONS
  The results of this study indicate that VSP for bimaxillary orthognathic surgery takes significantly less time and is less expensive than standard planning for the 3 types of cases analyzed.
authors.affiliation: Instructor, Harvard School of Dental Medicine; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: Cory.Resnick@childrens.harvard.edu.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Resnick
authors.affiliation: Dental Student, Harvard School of Dental Medicine, Boston, MA.
authors.forename: Gino
authors.initials: G
authors.lastname: Inverso
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Wrzosek
authors.affiliation: Associate Professor, Harvard School of Dental Medicine; Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Padwa
authors.affiliation: Walter C. Guralnick Distinguished Professor, Harvard School of Dental Medicine; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Kaban
authors.affiliation: Assistant Professor, Harvard School of Dental Medicine; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Peacock
mesh_terms: D002508:Cephalometry / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery; D017090:Occlusal Splints / Q000191:economics*; D056948:Orthognathic Surgical Procedures / Q000191:economics*; D010347:Patient Care Planning / Q000191:economics*; D066330:Printing, Three-Dimensional / Q000191:economics*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000191:economics*; D014584:User-Computer Interface