Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland.
J Plast Reconstr Aesthet Surg. 2012 Jan;65(1):17-21. doi: 10.1016/j.bjps.2011.07.028. Epub 2011 Aug 27.
The effects of reduction mammaplasty (RM) have been proved in several randomised trials. However, publications regarding cost utility are infrequent and lacking with regard to medium-term follow-up. Therefore, we decided to assess the cost utility of RM at 2-5 years' follow-up, when later costs and possible re-operations have been incurred.
A total of 73 patients had bilateral RM between January 2005 and March 2007 in the Hospital District of Helsinki and Uusimaa, Finland. Health-related quality of life was measured with the 15D. Preoperative data were collected with an interview at an appointment and follow-up data by means of a postal survey. Direct hospital costs were obtained from the Ecomed(®) clinical patient administration database (Datawell Ltd., Espoo, Finland).
A total of 62 (85%) patients agreed to participate in the study and returned the follow-up questionnaire. The mean follow-up time was 4.0 years (SD 0.53, range 2.3-4.6 years). The mean improvement in the 15D score change was 0.083 (SD 0.081). The mean number of quality-adjusted life years (QALYs) gained was 3.052 (SD 3.167, range 2.561-17.553). The mean hospital costs of the intervention were €3601 (SD 1321), and the mean cost per QALY gained was €1180. Roughly 76% of the costs were due to the hospital stay during the operation. Eight percent of the costs were incurred more than 6 months after the hospital stay.
The cost per QALY gained by RM is low, even when considering later costs caused by possible re-operations, and compares favourably with a number of other surgical procedures.
缩乳术（RM）的效果已在多项随机试验中得到证实。然而，关于成本效用的出版物很少，且缺乏中期随访的相关内容。因此，我们决定评估 RM 在 2-5 年随访时的成本效用，因为此时已经产生了后期成本和可能的再次手术。
2005 年 1 月至 2007 年 3 月，芬兰赫尔辛基和乌西玛大区医院共对 73 例双侧 RM 患者进行了手术。采用 15D 评估健康相关生活质量。术前数据通过预约访谈收集，随访数据通过邮寄调查收集。直接医院成本从 Ecomed（®）临床患者管理数据库（Datawell Ltd.，埃斯波，芬兰）获得。
共有 62（85%）例患者同意参与研究并返回了随访问卷。平均随访时间为 4.0 年（SD 0.53，范围 2.3-4.6 年）。15D 评分变化的平均改善值为 0.083（SD 0.081）。平均获得的质量调整生命年（QALY）数为 3.052（SD 3.167，范围 2.561-17.553）。干预措施的平均医院成本为 3601 欧元（SD 1321），每获得一个 QALY 的平均成本为 1180 欧元。约 76%的成本是由于手术期间的住院费用。8%的成本发生在住院后 6 个月以上。
即使考虑到可能再次手术引起的后期成本，RM 每获得一个 QALY 的成本仍然较低，且与许多其他手术相比具有优势。
