Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Abstract

Background: Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. Materials and methods: A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. Results: The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. Conclusion: Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.

Efficacy and safety of equine cartilage for rhinoplasty: a multicenter double-blind non-inferiority randomized confirmatory clinical trial

“…In a meta-analysis, there was no difference between autologous and homologous rib cartilage grafts in terms of warping, resorption, infection, contour irregularity, or revisions [ 25 ]. Furthermore, in a cost-utility analysis comparing rhinoplasty using costal cartilage autograft and homologous graft in the United States, the cost of rhinoplasty without hospitalization was similar [ 26 ]. However, with the complications associated with harvesting rib cartilage, the cost increased up to $21,099 [ 26 ].…”

“…Furthermore, in a cost-utility analysis comparing rhinoplasty using costal cartilage autograft and homologous graft in the United States, the cost of rhinoplasty without hospitalization was similar [ 26 ]. However, with the complications associated with harvesting rib cartilage, the cost increased up to $21,099 [ 26 ]. This study shows that the upper limit of cost for rhinoplasty using homologous graft can be lower than that of rhinoplasty using autologous rib cartilage.…”

An update on rib grafting in rhinoplasty: which rib is right?

“…A key and interesting potential differentiator between homologous and autologous rib cartilage is cost utility. This was studied by Starr et al [22 ▪▪ ] in 2021. This group reported a cost utility analysis and found that the cost of primary outpatient rhinoplasty using homologous rib was $8075 and $8342 for autogenous harvested rib.…”

“…Although these two prices were markedly similar, factors such as hospital admission for postoperative pain control increased the cost to $13 653, and up to $21 099 if admission was complicated by a pneumothorax in patients with rib harvest. Although using irradiated homologous rib cartilage saves on operative time, which presents costs similar to autologous rib, an inpatient stay or postoperative complication associated with autologous rib harvest highlights increased potential costs with using autologous ribs [22 ▪▪ ]. These data can be considered in the context of individual time required to harvest rib cartilage as well as complication rates, which are rare as previously described.…”

Considerations for Optimal Grafting in Rhinoplasty

“…25 A cost-analysis of using autologous and cadaveric grafts in rhinoplasty demonstrated comparable costs for both except when a complication was incurred from rib harvest. 26…”