A cost‐effectiveness analysis of DIEP vs free MS‐TRAM flap for microsurgical breast reconstruction

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.