Direct Hospital Cost of Outcome Pathways in Implant-Based Reconstruction with Acellular Dermal Matrices.
BACKGROUND
Current cost data on tissue expansion followed by exchange for permanent implant (TE/I) reconstruction lack a necessary assessment of the experience of a heterogenous breast cancer patient population and their multiple outcome pathways. We extend our previous analysis to that of direct hospital cost as bundling of payments is likely to follow the changing centralization of cancer care at the hospital level.


METHODS
We performed a retrospective analysis (2003-2009) of TE/I reconstructions with or without an acellular dermal matrix (ADM), namely Alloderm RTM. Postreconstructive events were analyzed and organized into outcome pathways as previously described. Aggregated and normalized inpatient and outpatient hospital direct costs and physician reimbursement were generated for each outcome pathway with or without ADM.


RESULTS
Three hundred sixty-seven patients were analyzed. The average 2-year hospital direct cost per TE/I breast reconstruction patient was $11,862 in the +ADM and $12,319 in the -ADM groups (P > 0.05). Initial reconstructions were costlier in the +ADM ($6,868) than in the -ADM ($5,615) group, but the average cost of subsequent postreconstructive events within 2 years was significantly lower in +ADM ($5,176) than -ADM ($6,704) patients (P < 0.05). When a complication occurred, but reconstruction was still completed within 2 years, greater costs were incurred in the -ADM than in the +ADM group for most scenarios, leading to a net equalization of cost between study groups.


CONCLUSIONS
Although direct hospital cost is an important factor for resource and fund allocation, it should not remain the sole factor when deciding to use ADM in TE/I reconstruction.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo. Strategic Health Resources.
Ali A
AA
Qureshi
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo. Strategic Health Resources.
Kristen
K
Broderick
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo. Strategic Health Resources.
Susan
S
Funk
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo. Strategic Health Resources.
Nancy
N
Reaven
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo. Strategic Health Resources.
Marissa M
MM
Tenenbaum
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo. Strategic Health Resources.
Terence M
TM
Myckatyn