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Cost Analysis of Two Staged Implants with Alloderm and Deep Inferior Epigastric Perforator Flap Autologous Reconstruction
Bao Ngoc Tran, M.D., Ayotunde Fadayomi, MBBS, MPH, Dhruv Singhal, MD, Bernard Lee, MD, MPH, MBA, FACS.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

PURPOSE: Two staged tissue expander-implant reconstruction with acellular matrix (TE/I+ADM) and deep inferior epigastric perforator flaps (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 their presumed cost effectiveness.
METHODS: We performed a comprehensive cost-utility analysis to compare (TE/I+ADM) and (DIEP). 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: The average cost for a successful TE/I+ADM and DIEP were $13,680.75 and $10,237.13 respectively. Incorporating pooled complication data from the published literature, an excess cost of $14,348.2 for TE/I+ADM and $11,395 for DIEP reconstruction was calculated. The expected costs for a successful TE/I+ADM and DIEP reconstruction were $9,974.63 and $7,395.30, significantly lower than the actual costs.
CONCLUSION: When comparing TE/I+ADM to DIEP flap reconstruction, DIEP flaps are more cost effective both at baseline and when factoring pooled complications and secondary procedures. These findings can be used to develop a decision analysis model when providing care to patients.


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