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A Novel Fat-Augmented Omentum-Based Construct Is A Cost-Effective Alternative For Autologous Breast Reconstruction
Pooja S. Yesantharao, MD, MS, Kassandra Carrion, BS, Dung H. Nguyen, MD, PharmD.
Stanford University, Palo Alto, CA, USA.
Purpose: The omental fat-augmented free flap (O-FAFF) is a novel technique for autologous breast reconstruction in women who cannot or who elect not to use more traditional donor sites. While the clinical outcomes of O-FAFF have been studied, associated costs and resource utilization are unknown. The O-FAFF technique involves use of acellular dermal matrix and a two-team approach for laparoscopic harvest of the omentum, thereby increasing surgical and materials costs. As such, this study compares the longitudinal cost-effectiveness study of O-FAFF breast reconstruction compared to reconstruction using implants or abdominal flaps.
Methods: Markov cohort modeling was used to study cost-effectiveness from the payer perspective. Effectiveness was measured in B-QALYs, derived from the BREAST-Q tool. The model horizon spanned 5 years and included any revision surgeries and costs of complications.
Results: Compared to implant-based reconstruction, the incremental cost of O-FAFF reconstruction was $9,227 and the incremental gain in B-QALY was 0.95, resulting in an incremental cost-effectiveness ratio of $9712.64/B-QALY gained, which is well under the acceptable cost-effectiveness threshold of $50,000 per B-QALY. Compared to abdominal flap reconstruction, O-FAFF reconstruction was associated with an incremental decrease in direct costs of $1,410.10 (due to fewer postoperative complications and downstream revisions) and an incremental gain in B-QALYs of 0.36 and was thus the dominant strategy.
Conclusions: The O-FAFF breast reconstruction technique is a cost-effective alternative to more traditional methods of breast reconstruction, including abdominal free flap techniques and implant-based reconstruction. As such, the O-FAFF technique represents an important novel modality for primary autologous reconstruction.
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