Comparison of nine methods of immediate breast reconstruction after resection of localized breast cancer: A cost‐effectiveness Markov decision analysis of prospective studies

Abstract

Background: Women undergoing immediate breast reconstruction without radiation therapy have reconstruction methods available with uncertain long-term costs associated with complications requiring surgery and revisions. We evaluated costeffectiveness of nine methods of immediate breast reconstruction for women with localized breast cancer.Methods: Markov modeling was performed over 10-years for unilateral/bilateral breast reconstructions from healthcare/societal perspectives. PubMed, Embase, Cochrane, Scopus, and CINAHL were searched to derive data from 13,744 patients in 79 prospective studies. Complications requiring surgery (mastectomy necrosis, total/partial flap necrosis, seroma, hematoma, infection, wound dehiscence, abdominal hernia, implant removal/explantation) and revisions (fat necrosis, capsular contracture, asymmetry, scars/redundant tissue, implant rupture/removal, fat grafting) were evaluated over yearly cycles. Reconstructions included: direct-to-implant (DTI), tissue expander-to-implant (TEI), latissimus dorsi flap-to-implant (LDI), latissimus dorsi (LD), pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator/superficial inferior epigastric artery (DIEP/SIEA), thigh-based, or gluteal based flaps. Outcomes were incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB).

Prepectoral Breast Reconstruction without Acellular Dermal Matrix: Have We Come Full Circle?

“…It is overall believed that autologous tissue-based reconstruction results in a better quality of life than implant-based alternatives [ 4 ]. Autologous breast reconstruction has also been shown to be the most long-term economical option, demonstrating the greatest net monetary benefits [ 5 ]. However, not all patients are candidates for autologous tissue reconstruction, and there are also patients who decline autologous reconstruction due to concerns regarding donor site or the length of the operation.…”