Hanover and Lebanon, N.H. From the Geisel School of Medicine at Dartmouth, Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, and the Tuck School of Business at Dartmouth.
Plast Reconstr Surg. 2013 May;131(5):953-961. doi: 10.1097/PRS.0b013e3182865a24.
The use of acellular dermal matrix has allowed for single-stage immediate breast reconstruction after mastectomy at a significantly decreased cost compared with two-stage expander/implant reconstruction. The use of a pedicled autologous dermal flap in the same fashion as acellular dermal matrix in women with larger, ptotic breasts has also allowed for single-stage immediate breast reconstruction with similarly low complication rates and without the added procedural cost of using acellular dermal matrix. There have been no prior studies evaluating whether the added procedural cost for acellular dermal matrix is cost-effective relative to using an autologous dermal flap in single-stage immediate breast reconstruction following mastectomy.
A comprehensive literature review was conducted to identify published complication rates for single-stage, implant-based immediate breast reconstruction using either acellular dermal matrix or an autologous dermal flap. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes and expert utility estimates to fit into a decision model to evaluate the cost-effectiveness of acellular dermal matrix.
: The decision model revealed a baseline cost difference of $261.72 and a 0.001 increase in the quality-adjusted life years when using acellular dermal matrix, yielding an incremental cost-utility ratio of $261,720 per quality-adjusted life year. Sensitivity analysis showed that acellular dermal matrix was not cost-effective when the complication rate for autologous dermal flaps was below 20 percent.
The authors' study demonstrates that acellular dermal matrix is not a cost-effective technology in patients who can have an autologous dermal flap in single-stage immediate breast reconstruction.
与两阶段扩张器/植入物重建相比，使用去细胞真皮基质可在显著降低成本的情况下实现乳房切除术后的单阶段即刻乳房重建。在乳房较大、下垂的女性中，以与去细胞真皮基质相同的方式使用带蒂自体真皮皮瓣，也可以实现单阶段即刻乳房重建，且并发症发生率相似，且无需增加使用去细胞真皮基质的程序成本。以前没有研究评估在乳房切除术后即刻乳房重建的单阶段中，使用去细胞真皮基质的额外程序成本相对于使用自体真皮皮瓣是否具有成本效益。
进行了全面的文献综述，以确定使用去细胞真皮基质或自体真皮皮瓣进行单阶段、基于植入物的即刻乳房重建的已发表并发症率。将最常见并发症的概率与医疗保险现行程序术语报销代码和专家效用估计值相结合，以拟合决策模型，评估去细胞真皮基质的成本效益。
决策模型显示，使用去细胞真皮基质的基线成本差异为 261.72 美元，质量调整生命年增加 0.001，增量成本效益比为每质量调整生命年 261720 美元。敏感性分析表明，当自体真皮皮瓣的并发症率低于 20%时，去细胞真皮基质不具有成本效益。
作者的研究表明，在可以进行单阶段即刻乳房重建的患者中，去细胞真皮基质不是一种具有成本效益的技术。
