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Randomized Controlled Trial
. 2019 Apr;106(5):586-595.
doi: 10.1002/bjs.11102. Epub 2019 Mar 5.

Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage expander-implant reconstruction from a multicentre randomized clinical trial

V L Negenborn  1   2 , J M Smit  1   3 , R E G Dikmans  1   2 , H A H Winters  1   2   3 , J W R Twisk  4 , P Q Ruhé  5 , M A M Mureau  6 , S Tuinder  7 , Y Eltahir  8 , N A S Posch  9 , J M van Steveninck-Barends  9 , R R W J van der Hulst  7   10 , M J P F Ritt  1 , M-B Bouman  1   2   3 , M G Mullender  1   2
Affiliations
Randomized Controlled Trial

Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage expander-implant reconstruction from a multicentre randomized clinical trial

V L Negenborn et al. Br J Surg. 2019 Apr.

Abstract

Background: Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct one-stage IBBR with use of an acellular dermal matrix (ADM) is more cost-effective than two-stage (expander-implant) breast reconstruction.

Methods: The BRIOS (Breast Reconstruction In One Stage) study was an open-label multicentre RCT in which women scheduled for skin-sparing mastectomy and immediate IBBR were randomized between one-stage IBBR with ADM or two-stage IBBR. Duration of surgery and hospital stay, and visits for the primary surgery, unplanned and cosmetic procedures were recorded. Costs were estimated at an institutional level. Health status was assessed by means of the EuroQol Five Dimensions 5L questionnaire.

Results: Fifty-nine patients (91 breasts) underwent one-stage IBBR with ADM and 62 patients (92 breasts) two-stage IBBR. The mean(s.d.) duration of surgery in the one-stage group was significantly longer than that for two-stage IBBR for unilateral (2·52(0·55) versus 2·02(0·35) h; P < 0·001) and bilateral (4·03(1·00) versus 3·25(0·58) h; P = 0·017) reconstructions. Costs were higher for one-stage compared with two-stage IBBR for both unilateral (€12 448 (95 per cent c.i. 10 722 to 14 387) versus €9871 (9373 to 10 445) respectively; P = 0·025) and bilateral (€16 939 (14 887 to 19 360) versus €13 383 (12 414 to 14 669); P = 0·002) reconstructions. This was partly related to the use of relatively expensive ADM. There was no difference in postoperative health status between the groups.

Conclusion: One-stage IBBR with ADM was associated with higher costs, but similar health status, compared with conventional two-stage IBBR. Registration number: NTR5446 ( http://www.trialregister.nl).

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Figures

Figure 1
Figure 1
Flow diagram for the trial *The patient underwent two‐stage implant‐based breast reconstruction (IBBR) because of the surgeon's intraoperative decision, and was included in the two‐stage group for analysis. †Included in final analysis. ADM, acellular dermal matrix.
See this image and copyright information in PMC

References

    1. John R, Ross H. The Global Economic Costs of Cancer. American Cancer Society and the LIVESTRONG Organization: Atlanta, 2010.
    1. WHO . Global Health Estimates 2000–2015 http://www.who.int/healthinfo/global_burden_disease/estimates/ [accessed 5 October 2017].
    1. Porter ME, Teisberg EO. Redefining Health Care: Creating Value‐based Competition on Results. Harvard Business School Press: Boston, 2006.
    1. American Cancer Society . How Common Is Breast Cancer? https://www.cancer.org/cancer/breast‐cancer/about/how‐common‐is‐breast‐c... [accessed 5 October 2017].
    1. Allemani C, Sant M, Weir HK, Richardson LC, Baili P, Storm H et al. Breast cancer survival in the US and Europe: a CONCORD high‐resolution study. Int J Cancer 2013; 132: 1170–1181. - PMC - PubMed

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