Cost-effectiveness of one-stage versus two-stage breast reconstruction in the United Kingdom

Abstract

of a saline implant and permit long-term, noninvasive adjustment of breast size. Reconstruction can, therefore, be completed as a single procedure. The implant is placed at the index procedure, expansion achieved with repeat outpatient injections of saline until optimum breast size is reached. The traditional two-stage reconstruction, however, involves two operations, the first involving the , at a mean of 12.9 months postimplantation, the majority of which were exchanged for silicone implants to improve cosmesis. Four (9%) of the two-stage procedures were explanted a mean of 18 months postreconstruction. Overall, one-stage reconstructions were significantly more expensive than the two-stage group (P = 0.016). Conclusion:There are many benefits of one-stage breast reconstruction. However, it does not appear to be cost-effective when additional admissions for explantation surgery are taken into account. Key words:Breast Received: 03-01-2015; Accepted: 24-09-2015 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Cost-effectiveness of single-use negative-pressure therapy compared with standard care for prevention of reconstruction failure in prepectoral breast reconstruction

“…The base case risk of reconstruction failure (8.6 per cent) was drawn from a large study across many centres in the UK 11 . The target rate according to breast reconstruction guidelines in the UK 26 is less than 5 per cent, and the recent study 12 from which the effectiveness of sNPWT was taken recorded a rate of around 4 per cent. Sensitivity analyses were therefore included based on these rates in addition to one-way analyses and a probabilistic model.…”

“…This evaluation has limitations. The effectiveness of sNPWT was based on a comparative study 12 that was not randomized. The authors 12 concluded that sNPWT should be considered at the surgeon’s discretion.…”

“…The effectiveness of sNPWT was based on a comparative study 12 that was not randomized. The authors 12 concluded that sNPWT should be considered at the surgeon’s discretion. The present analysis models the cost implications of this decision, but is based on this particular study.…”

“…A multicentre UK study 11 found an implant loss rate of around 9 per cent at 3 months. Reconstruction failure may be associated with increased resource utilization for the health system, including hospital attendances and readmissions 12–14 . Further surgical procedures, such as explantation, insertion of tissue expanders and reimplantation, may be necessary 12 .…”

“…Following mastectomy and implant-based reconstruction, the use of sNPWT led to a reduction in the incidence of reconstruction failure compared with standard surgical dressings. The cost of a reconstruction failure was estimated to be over £14 000, taking into account the need for multiple readmissions to hospital and outpatient visits 12 .…”