Cost‐utility analysis comparing free and pedicled TRAM flap for breast reconstruction

Thoma, Achilleas; Khuthaila, Dana; Rockwell, Gloria; Veltri, Karen

doi:10.1002/micr.10138

Cited by 79 publications

(74 citation statements)

References 42 publications

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“…Most of the studies focused on some form of orthopedic or spinal surgery, and one each referred to cesarean delivery [35], open abdominal surgery [36], breast reconstruction [37], and cardiac surgery [38].…”

Section: Resultsmentioning

confidence: 99%

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Health Utility Values Associated with Surgical Site Infection: A Systematic Review

et al. 2015

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Section: Resultsmentioning

confidence: 99%

“…The SSI utility decrement ranged from values as low as 0.04 [41] to as high as 0.48 [42]. The utility decrement ranged between 0.1 and 0.2 in eight studies [17,37,38,[43][44][45][46][47] and between 0.2 and 0.4 in three studies [18,35,39].…”

Section: Model-based Economic Evaluationsmentioning

confidence: 98%

Health Utility Values Associated with Surgical Site Infection: A Systematic Review

et al. 2015

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“…The free TRAM technique was shown to be more cost effective than the unipedicled TRAM (33). In sequence, the DIEP flap was found to be more cost effective than the free TRAM flap (34).…”

Section: Examples Of Economic Evaluations In Plastic Surgerymentioning

confidence: 95%

“…Deterministic analysis calculates expected costs (for example, from the Canadian health care system) and components of QALY (duration and utilities of health states; future remaining life expectancy -duration of health state and utility of successful intervention) through a review of the plastic surgery literature (9). To illustrate deterministic analysis, a free versus unipedicled TRAM flap (for postmastectomy breast reconstruction) example will be used (33). In this analysis, the perspective was the Ministry of Health (Ontario), utilities were obtained from plastic surgeon 'experts' across Canada via a questionnaire that included various health states (complications) retrieved from published literature.…”

Section: Precision Of Cost-utility Analysesmentioning

confidence: 99%

The performance and publication of cost-utility analyses in plastic surgery: Making our specialty relevant

Thoma¹,

Ignacy

Ziolkowski³

et al. 2012

Canadian Journal of Plastic Surgery

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Increased spending and reduced funding for health care is forcing decision makers to prioritize procedures and redistribute funds. Decision making is based on reliable data regarding the costs and benefits of medical and surgical procedures; such a study design is known as an economic evaluation. The onus is on the plastic surgery community to produce high-quality economic evaluations that support the cost effectiveness of the procedures that are performed. The present review focuses on the cost-utility analysis and its role in deciding whether a novel technique/procedure/technology should be accepted over one that is prevalent. Additionally, the five steps in undertaking a cost-utility (effectiveness) analysis are outlined.

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“…However, previous cost-effectiveness studies (17,18) found that the introduction of techniques that caused less disruption of muscle and fascia were cost-effective in the Canadian health care system.…”

mentioning

confidence: 98%

A comparison of the superficial inferior epigastric artery flap and deep inferior epigastric perforator flap in post-mastectomy reconstruction: A cost-effectiveness analysis

Thoma¹,

Jansen²,

Sprague³

et al. 2008

J Plastic Surgery

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PURPOSE: To perform a cost-effectiveness analysis comparing the superficial inferior epigastric artery (SIEA) and deep inferior epigastric perforator (DIEP) flaps in postmastectomy reconstruction. METHODS: A decision analytic model with seven clinically important health outcomes (health states) was used, incorporating the Ontario Ministry of Health's perspective. Direct medical costs were estimated from a university-based hospital. The utilities of each health state converted into quality-adjusted life years (QALYs) were obtained from previously published data. Health state probabilities were computed from a systematic literature review. Analyses yielded SIEA and DIEP expected costs and QALYs allowing calculation of the incremental cost-utility ratio (ICUR). One-way sensitivity analyses were conducted under five plausible scenarios, assessing result robustness. RESULTS: Five SIEA and 27 DIEP studies were identified. The baseline SIEA expected cost was slightly higher than that for the DIEP ($16,107 versus $16,095), with slightly higher QALYs (33.14 years versus 32.98 years), giving an ICUR of $77/QALY. Taking into account conversions from SIEA to DIEP, the ICUR increased to $4,480/QALY. Sensitivity analysis gave ICURs ranging from $2,614/QALY to 'dominant', all consistent with the adoption of the SIEA over the DIEP. CONCLUSION: The best available evidence suggests the SIEA is a cost-effective procedure. However, given the high SIEA to DIEP conversion rates and small marginal differences in cost and effectiveness, the ICUR may be sensitive to minor changes in costs or QALYs. The 'truth' can only be obtained from a randomized, controlled trial comparing both techniques side by side, simultaneously capturing the costs of the competing interventions.Key Words: Breast reconstruction; Cost-effectiveness; Cost-utility analysis; Quality-adjusted life years; Postmastectomy Une comparaison entre le lambeau de l'artère épigastrique inférieure superficielle et le lambeau perforant de l'artère épigastrique inférieure profonde dans le cadre d'une reconstruction après une mastectomie : Une analyse coût-efficacité OBJECTIF : Effectuer une analyse coût-efficacité comparant un lambeau de l'artère épigastrique inférieure superficielle (SIEA) à un lambeau perforant de l'artère épigastrique inférieure profonde (DIEP) pour la reconstruction après une mastectomie. MÉTHODOLOGIE : Les auteurs ont utilisé un modèle d'analyse déci-sionnelle comportant sept issues de santé importantes d'un point de vue clinique (états de santé), incluant la perspective du ministère de la Santé de l'Ontario. Ils ont estimé les coûts médicaux directs d'après un hôpital universitaire. Ils ont obtenu l'utilité de chaque état de santé converti en années de vie pondérées par la qualité (AVPQ) dans des données déjà publiées. Ils ont calculé les probabilités relatives aux états de santé au moyen d'une analyse bibliographique systématique. Les analyses ont fourni les coûts prévus des SIEA et des DIEP ainsi que de l'AVPQ et ont ainsi permis le calcul du ratio coût-u...

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Cost‐utility analysis comparing free and pedicled TRAM flap for breast reconstruction

Cited by 79 publications

References 42 publications

Health Utility Values Associated with Surgical Site Infection: A Systematic Review

Health Utility Values Associated with Surgical Site Infection: A Systematic Review

The performance and publication of cost-utility analyses in plastic surgery: Making our specialty relevant

A comparison of the superficial inferior epigastric artery flap and deep inferior epigastric perforator flap in post-mastectomy reconstruction: A cost-effectiveness analysis

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