Cost-Effectiveness Analysis Parallel to a Randomized Controlled Trial Comparing Vertical Scar Reduction and Inverted T–Shaped Reduction Mammaplasty

Abstract

Vertical scar reduction is more likely than not cost-effective from patient and societal perspectives but not from the Ministry of Health perspective at a willingness-to-pay threshold of $50,000 per quality-adjusted life-year. If we limit vertical scar reduction for resections less than 500 g per breast, this technique is more likely cost-effective from all perspectives.

A Systematic Review of Health Economic Evaluation Studies Using the Patient’s Perspective

“…Of the 30 articles included in the review , 21 were CEAs [16,[18][19][20][21][22][23][24][25][27][28][29][30][31][32][33][34][35][36][37]39], 4 were CUAs [17,26,38,40], 4 were CBAs [42][43][44][45], and 1 consisted of both CEA and CBA [41]. Among those studies, 7 were conducted in the United States [17,20,23,24,28,44,45], 9 in Europe [16,26,[31][32][33][34]37,41,43], 7 in Asia [25,27,29,30,35,…”

“…More than a half of the studies (n ¼ 17) conducted their economic analyses using the patient's perspective and at least one more perspectives such as societal (n ¼ 5) [21,25,31,40,41], government or payer (n ¼ 5) [28,30,31,34,40], and health care provider, for example, health system, hospital, or clinic (n ¼ 11) [16][17][18][19][21][22][23][24]27,29,41]. Trial analysis was the most frequently used methodology (n ¼ 16) [20,23,26,27,[29][30][31][32][33][36][37][38][39][40]42,44], followed by decision-tree model (n ¼ 5) [16,17,25,28,34] and observational analysis (n ¼ 5) [19,[21][22][23]35,41,…”

“…Trial analysis was the most frequently used methodology (n ¼ 16) [20,23,26,27,[29][30][31][32][33][36][37][38][39][40]42,44], followed by decision-tree model (n ¼ 5) [16,17,25,28,34] and observational analysis (n ¼ 5) [19,[21][22][23]35,41,45]. For patient costs, all except 1 study accounted for direct medical costs [27], 17 studies included direct nonmedical costs [17,[19][20][21][22][25][26][27][29][30][31][32]35,[39][40][41]43,45], and 15 studies estimated indirect costs [19,20,[23]…”

“…CEA results were reported as the average cost-effectiveness ratio in 5 studies [18,27,29,35,39], whereas the incremental costeffectiveness ratio or the incremental cost-utility ratio was reported in 13 studies [17,[19][20][21][22]24,26,28,32,33,36,40]. Three of the five CBA studies adopted the willingness-to-pay approach to estimate benefits [42][43][44].…”

Preemptive Analgesia with Bupivacaine in Reduction Mammaplasty

“…W e read with great interest the results of the clinical trial evaluating preemptive analgesia with bupivacaine in reduction mammaplasty. 1 We congratulate the author on conducting one of the very few known Level I evidence studies in reduction mammaplasty.…”