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A cost‐effectiveness analysis of DIEP vs free MS‐TRAM flap for microsurgical breast reconstruction
Author(s) -
Tan Marcus G.,
Isaranuwatchai Wanrudee,
DeLyzer Tanya,
Butler Kate,
Hofer Stefan O. P.,
O'Neill Anne C.,
Zhong Toni
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25325
Subject(s) - diep flap , medicine , breast reconstruction , surgery , free flap , abdomen , patient satisfaction , rectus abdominis muscle , cost analysis , abdominal hernia , abdominal wall , breast cancer , cancer , engineering , reliability engineering
Background and Objectives The deep inferior epigastric perforator (DIEP) flap may be associated with less long‐term donor‐site morbidity compared with free muscle‐sparing transverse rectus abdominis myocutaneous flap (MS‐TRAM) flap. However, DIEP flaps may have longer operative time and higher rates of acute postoperative complications. We performed a cost‐effectiveness analysis (CEA) that compared the long‐term costs and patient‐reported outcomes between the two flaps. Methods A retrospective cohort of women who received free MS‐TRAM or DIEP flap reconstruction between January 2008 and December 2012, with a minimum of 2‐year follow‐up, were recruited. Cost data of the primary reconstruction and any subsequent hospitalization due to complications from the reconstruction within 2 years were obtained. Each patient received a BREAST‐Q questionnaire at 2 years post‐reconstruction. Results In total, 227 patients (180 DIEP, 47 free MS‐TRAM) were included. DIEP patients had significantly fewer abdominal hernia ( P = 0.04). The adjusted‐incremental cost‐effectiveness ratios found that DIEP flap was more cost‐effective to free MS‐TRAM flap in the domains of “Physical Well‐Being of the Abdomen” and “Satisfaction with Outcome.” Conclusions DIEP flap is the more cost‐effective method of autologous breast reconstruction in the long‐term compared with free MS‐TRAM flap with respect to patient‐reported abdominal well‐being and overall satisfaction with the outcome.