From the Gillings School of Global Public Health, the Department of Otolaryngology/Head and Neck Surgery, and the Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill.
Plast Reconstr Surg. 2019 Apr;143(4):1185-1194. doi: 10.1097/PRS.0000000000005418.
Because of the complex nature of osteocutaneous free flap mandibular reconstruction, modern technologies such as virtual surgical planning have become popularized to refine the procedure. Compared with usual care, virtual surgical planning has been suggested to reduce operative time and improve accuracy of outcomes. The aim of this study was to examine the cost-effectiveness of virtual surgical planning versus usual care in mandibular reconstruction.
A decision-analytic model was constructed to comparatively understand cost-effectiveness of virtual surgical planning and usual care treatments based on additional costs of virtual surgical planning, and costs attributed to probabilities of postoperative complications. Model structure was informed through qualitative clinical interviews from the University of North Carolina, and supported through University of North Carolina clinical data and literature. Costs and complication probabilities were estimated from the literature. Sensitivity analyses of all uncertain model parameters were performed, and distributional parameters were selected based on best practices.
Results of base-case analysis indicated that virtual surgical planning was more costly by a difference of $7099 per person and did not reduce the risk of complications or flap loss. Virtual surgical planning cases had an increased incidence of flap loss by 0.6 percent and an increased incidence of mandibular infection by 6.5 percent.
Virtual surgical planning has upfront expenses that do not necessarily translate into downstream reduction in complications or improved outcomes. Clinical decision-makers would benefit from future research to identify thresholds whereby virtual surgical planning may result in more cost-savings for particular types of patients.
由于骨皮瓣游离下颌骨重建的复杂性，虚拟手术规划等现代技术已经普及，以完善该手术。与常规护理相比，虚拟手术规划被认为可以减少手术时间并提高手术结果的准确性。本研究旨在探讨虚拟手术规划与常规护理在下颌骨重建中的成本效益。
构建了一个决策分析模型，通过比较虚拟手术规划和常规护理治疗的附加成本以及术后并发症概率所产生的成本，来比较评估虚拟手术规划和常规护理治疗的成本效益。通过北卡罗来纳大学的定性临床访谈来构建模型结构，并通过北卡罗来纳大学的临床数据和文献来支持。成本和并发症概率是从文献中估算得出的。对所有不确定模型参数进行了敏感性分析，并根据最佳实践选择了分布参数。
基于基本情况分析的结果表明，虚拟手术规划的成本要高出 7099 美元/人，而且并没有降低并发症或皮瓣丢失的风险。虚拟手术规划病例中皮瓣丢失的发生率增加了 0.6%，下颌感染的发生率增加了 6.5%。
虚拟手术规划有前期费用，但不一定能转化为减少并发症或改善结果的效果。临床决策者将受益于未来的研究，以确定虚拟手术规划可能为特定类型的患者带来更多成本节约的阈值。
