Cost-Effectiveness Analysis of Immediate Tissue Engineering Bone Graft Versus Fibula-Free Flap Reconstruction for Mandibular Continuity Defects Secondary to Benign Pathology.

BACKGROUND

Tissue engineering (TE) offers a potential alternative to fibula-free flap (FFF) reconstruction and may reduce surgical complexity, hospital stay, and health care costs.

PURPOSE

The purpose of this study is to estimate and compare the cost-effectiveness of immediate TE and FFF reconstruction.

STUDY DESIGN, SETTING, SAMPLE: This study was designed as a retrospective cohort conducted at the University of Texas Health Science Center at Houston from November 2015 to March 2024. Exclusion criteria included subjects with malignant pathologies, those treated with only a fasciocutaneous graft, cases of osteoradionecrosis, and those with incomplete records.

PREDICTOR VARIABLE

The primary predictor variable was the type of reconstruction method, either TE bone grafts or FFF reconstruction.

MAIN OUTCOME VARIABLES

The main outcome variable was cost-effectiveness which was defined as cost per successful reconstruction. Successful reconstruction was defined as complete union more than 1 year postoperatively without the need for revision surgery and the absence of postoperative complications requiring take-back surgery.

COVARIATES

Covariates include age, sex, defect size, and American Society of Anesthesiologists classification.

ANALYSES

R statistical software was used for data analysis. Statistical significance was defined as P < .05.

RESULTS

The sample was composed of 31 subjects with a mean age of 44.97 ± 18.46 years for TE and 41.93 ± 18.23 years for FFF (P = .7). There were 18 (58%) and 13 (42%) subjects in TE and FFF, respectively. The proportion of successful reconstructions was 95% (n = 18) for TE and 77% (n = 13) for FFF (P = .6). The mean total hospital charges for TE were $247,172 ± $54,080 (P < .001) and $423,008 ± $59,571.75 (P < .001) for FFF. The cost per successful reconstruction was $261,711.64 for TE and $549,910.40 for FFF.

CONCLUSIONS AND RELEVANCE

TE may be a more cost-effective alternative to FFF, providing comparable reconstructive success with reduced cost, surgical time, and hospital resource utilization.