Abstract

LAGARES-BORREGO, A. et al. Accurate cost of breast reconstruction with DIEP flap and implants in a public hospital in the Spanish healthcare system. Cir. plást. iberolatinoam. [online]. 2015, vol.41, n.4, pp.399-407. ISSN 1989-2055.  https://dx.doi.org/10.4321/S0376-78922015000400007.

Mastectomy breast reconstruction can be a significant consumption of human and financial resources for any health system. The purpose of this study is whether the economic weight assigned by the Spanish National Health System as encoding by Healthcare Resource Groups to two major breast reconstruction procedures fits true estimate of patients. A retrospective cohort study has been performed to evaluate the economic cost of 134 patients operated on for unilateral breast reconstruction delayed by the expander-prosthesis (E-P) and deep inferior epigastric artery perforator flap (DIEP) procedures during the period between 2005 and 2013. The data analyzed and economic cost estimated of the patients were in-hospital and out-patient direct costs of both the initial reconstruction surgery as secondary procedures. Patients undergoing E-P reconstruction required a higher number of surgery sessions to complete the reconstruction procedure and showed higher rates of surgery-related complications. The percentage of surgery required for aesthetic retouch was higher in patients reconstituted with DIEP flap. No statistically significant differences were found regarding total cost between the two cohorts (18.857,77 € DIEP vs 20.502,08 € E-P, p = 0,89). Total cost of breast reconstruction according Healthcare Resource Groups was lower than total estimated cost of patients for both cohorts (11.596,43 € vs € 18.857,77 €, p < 0.001 DIEP; 13,565.82 vs 20,502.08 €, p < 0.001 E-P). The cost of breast reconstruction is inadequately tariffed by health managers; the cost using Healthcare Resource Groups is less than the estimated cost of the patients to either procedures. We consider that DIEP flap reconstruction is more cost-effective than E-P reconstruction, as it requires less surgical procedures, presents lower complication rate and remains more stable over time.

Keywords : Breast reconstruction; Deep inferior epigastric artery perforator flap; DIEP; Breast implants; Cost analysis; Healthcare resource groups.

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