乳房重建方法的可变性提供了一个机会来研究一种方法在成本方面是否优于另一种方法。质量,或者两者兼而有之。我们根据一项随机临床试验的三级终点数据进行了成本-效果分析(CEA)研究,以比较背阔肌皮瓣(LD)或胸背动脉穿支皮瓣(TAP)延迟乳房重建的成本-效果。
共有50名妇女接受单侧延迟乳房重建,并随机接受LD皮瓣(n=18)或TAP皮瓣(n=22)的重建。CEA基于重建后肩关节功能的差异。与这两个程序有关的直接和间接成本由丹麦诊断相关小组关税评估。
我们的分析表明,引入TAP皮瓣对总肩评分具有显着的积极作用,额外费用为$2779。增量成本效益比为4481美元,根据支付意愿(WTP)500美元,我们发现估计的净收益为519美元,具有统计学意义(p=0.0375)。成本效益可接受性曲线表明,在500美元的WTP阈值下,TAP襟翼对LD襟翼的成本效益为96.3%。
从社会的角度来看,我们的成本效益分析表明,就患者报告的肩关节残疾而言,与LD皮瓣相比,TAP皮瓣是更具成本效益的乳房再造方法.
Variability in breast reconstruction methods provides an opportunity to investigate whether a method is superior to another with regard to cost, quality, or both. We performed a cost-effectiveness analysis (CEA) study based on tertiary endpoint data from a randomized clinical trial to compare the cost-effectiveness of delayed breast reconstruction by either a latissimus dorsi flap (LD) or a thoracodorsal artery perforator flap (TAP).
A total of 50 women were included for unilateral delayed breast reconstruction and were randomized to reconstruction by either the LD flap (n = 18) or the TAP flap (n = 22). The CEA was based on differences in shoulder function after the reconstruction. Direct and indirect costs relating to the two procedures were assessed by the Danish Diagnosis-Related Groups tariffs.
Our analysis showed a significant positive effect of introducing the TAP flap on the total shoulder score with an additional cost of $2779. The incremental cost-effectiveness ratio was $4481 and based on a willingness to pay (WTP) $500, we found an estimated net benefit of $519, which was statistically significant (p = 0.0375). The cost-effectiveness acceptability curve indicated that there is a 96.3% probability for the TAP flap being cost-effective to the LD flap at a WTP threshold of $500.
From a societal perspective, our cost-effective analysis demonstrated that the TAP flap is the more cost-effective method of breast reconstruction compared to the LD flap with respect to patient-reported shoulder-related disability.