Department of Plastic surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Plastic and Reconstructive Surgery, Gothenburg, Sweden.
Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Plast Surg Hand Surg. 2024 Jan 8;59:1-13. doi: 10.2340/jphs.v59.19649.
There are several techniques for reconstructing breasts after mastectomy, but little scientific evidence for which technique is superior. The aim of this systematic review was to compare the cost-effectiveness of implant-based and autologous reconstruction and to evaluate the overall certainty of evidence, as well as the quality of reporting of the included studies.
Studies investigating the cost-effectiveness of breast reconstruction with a deep inferior epigastric perforator (DIEP) flap compared to implant-based reconstruction, meeting criteria defined in a PICO (population, intervention, comparison, and outcome), were included. Medline, PubMed, Embase, Cochrane library, CinahL, EconLit, and NHS EED databases were searched. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence, and the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 was used to evaluate the quality of reporting.
A total of 256 abstracts were retrieved from the search, and after scrutiny, seven studies were included. The findings of this present systematic review should be interpreted with caution as the overall certainty of evidence is low (GRADE ƟƟОО). The included studies suggest that DIEP-flaps are cost-effective compared with implant-based breast reconstruction when the applied cost-effectiveness thresholds of $50,000 to $100,000 per quality-adjusted life years are used. It is noteworthy that no high level evidence exists regarding cost-effeciency, to support recommendations and decision in breast reconstruction. Methodological issues that can be improved in future studies are presented.
乳房切除术后有几种乳房重建技术，但哪种技术更优的科学证据很少。本系统评价的目的是比较基于植入物和自体重建的成本效益，并评估证据的整体确定性，以及纳入研究的报告质量。
纳入了使用深部下腹壁穿支皮瓣（DIEP）与基于植入物的重建相比，符合 PICO（人群、干预、比较和结果）定义标准的乳房重建成本效益研究。检索了 Medline、PubMed、Embase、Cochrane 图书馆、CinahL、EconLit 和 NHS EED 数据库。使用推荐评估、制定与评价（GRADE）方法评估证据的确定性，并使用 2022 年健康经济评估报告标准（CHEERS）评估报告质量。
从搜索中总共检索到 256 篇摘要，经过仔细审查，纳入了 7 项研究。由于证据的整体确定性较低（GRADE ƟƟОО），本系统评价的结果应谨慎解释。纳入的研究表明，当使用每质量调整生命年 50,000 至 100,000 美元的应用成本效益阈值时，DIEP 皮瓣与基于植入物的乳房重建相比具有成本效益。值得注意的是，没有关于成本效益的高级证据可以支持乳房重建的建议和决策。提出了可以在未来研究中改进的方法学问题。
