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Post-Mastectomy Tissue Expander Placement Followed by Radiation Therapy: A Cost-Effectiveness Analysis of Staged Autologous Versus Implant-Based Unilateral Reconstruction

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is no preferred approach to breast reconstruction for patients with locally advanced breast cancer (LABC) who require post-mastectomy radiation therapy (PMRT). Staged implant and autologous reconstruction both have unique risks and benefits. No previous study has compared their cost-effectiveness with utility scores.

Methods

A literature review determined the probabilities and outcomes for mastectomy and staged implant or autologous reconstruction. Utility scores were used to calculate the quality-adjusted life years (QALYs) associated with successful surgery and postoperative complications. Medicare billing codes were used to assess costs. A decision analysis tree was constructed with rollback and incremental cost-effectiveness ratio (ICER) analyses. Sensitivity analyses were performed to validate results and account for uncertainty.

Results

Mastectomy with staged deep inferior epigastric perforator (DIEP) flap reconstruction is costlier ($14,104.80 vs $3216.93), but more effective (QALYs, 29.96 vs 24.87). This resulted in an ICER of 2141.00, favoring autologous reconstruction. One-way sensitivity analysis showed that autologous reconstruction was more cost-effective if less than $257,444.13. Monte Carlo analysis showed a confidence of 99.99% that DIEP flap reconstruction is more cost-effective.

Conclusions

For patients with LABC who require PMRT, staged autologous reconstruction is significantly more cost-effective than reconstruction with implants. Despite the decreased morbidity, staged implant reconstruction has greater rates of complication.

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Author information

Author notes

  1. Dr. Bloom and Ms. Shah are co-first authors and contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Tufts Medical Center, Boston, MA, USA

    Joshua A. Bloom MD

  2. Harvard Medical School, Boston, MA, USA

    Shivani A. Shah BS

  3. Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Emily A. Long MD & Bernard T. Lee MD, MPH, MBA

  4. Division of Plastic and Reconstructive Surgery, Tufts Medical Center, Boston, MA, USA

    Abhishek Chatterjee MD, MBA

Authors
  1. Joshua A. Bloom MD
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  2. Shivani A. Shah BS
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  3. Emily A. Long MD
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  4. Abhishek Chatterjee MD, MBA
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  5. Bernard T. Lee MD, MPH, MBA
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Corresponding author

Correspondence to Bernard T. Lee MD, MPH, MBA.

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Disclosures

Abhishek Chatterjee was a non-paid consultant (no money/grants/etc. exchanged) in a collaborative publication effort with Allergan that makes implants. The remaining authors have no conflicts of interest.

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Bloom, J.A., Shah, S.A., Long, E.A. et al. Post-Mastectomy Tissue Expander Placement Followed by Radiation Therapy: A Cost-Effectiveness Analysis of Staged Autologous Versus Implant-Based Unilateral Reconstruction. Ann Surg Oncol 30, 1075–1083 (2023). https://doi.org/10.1245/s10434-022-12619-5

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  • DOI: https://doi.org/10.1245/s10434-022-12619-5

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