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Cost Analysis of Two Staged Implants with Alloderm and Deep Inferior Epigastric Perforator Flap Autologous Reconstruction
Bao Ngoc N. Tran, MD, Ayotunde Fadayomi, MBBS, MPH, Samuel J. Lin, MD, MBA, Dhruv Singhal, MD, Bernard T. Lee, MD, MBA, MPH, FACS.
Department of Surgery, Division of Plastic and Reconstructive Surgery. Beth Israel Deaconess Medical Center, Boston, MA, USA.

PURPOSE: Two staged tissue expander-implant with acellular matrix (TE/I+ADM) and deep inferior epigastric perforator flap (DIEP) are the most common implant and autologous methods of reconstruction in the U.S. respectively. Implant based techniques are disproportionally more popular, partially due to its presumed cost effectiveness. We performed a comprehensive cost-utility analysis to compare (TE/I+ADM) and (DIEP).
METHODS: A comparative cost analysis of (TE/I+ADM) and (DIEP) was performed. Medicare reimbursement costs for each procedure and their associated complications were calculated. Pooled probabilities of complications including cellulitis, seroma, skin necrosis, implant removal, flap loss, partial flap loss, and fat necrosis, were calculated using studies from 2010-2016.
RESULTS: A comparative cost analysis of (TE/I+ADM) and (DIEP) was performed. Medicare reimbursement costs for each procedure and their associated complications were calculated. Pooled probabilities of complications including cellulitis, seroma, skin necrosis, implant removal, flap loss, partial flap loss, and fat necrosis, were calculated using studies from 2010-2016.
CONCLUSION: When comparing TE/I+ADM to DIEP reconstruction, DIEP is more cost effective at baseline and also with additional pooled complications. This might be due to the second stage procedure to replace TE with permanent implants. Such finding can be used as a decision analysis model in providing care to patients.


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