TY - JOUR
T1 - Comparing Health Care Resource Use between Implant and Autologous Reconstruction of the Irradiated Breast
T2 - A National Claims-Based Assessment
AU - Aliu, Oluseyi
AU - Zhong, Lin
AU - Chetta, Matthew D.
AU - Sears, Erika D.
AU - Ballard, Tiffany
AU - Waljee, Jennifer F.
AU - Chung, Kevin C.
AU - Momoh, Adeyiza O.
N1 - Funding Information:
Support for this study was provided in part by grants from the Michigan Institute for Clinical and Health Research (to A.O.M. and E.D.S.), and a Midcareer Investigator Award in Patient-Oriented Research (2K24 AR053120-06) (to K.C.C.). Jennifer F Waljee, MD M.S., receives research funding from the Agency for Healthcare Research and Quality (K08 1K08HS023313-01), the American College of Surgeons, and the American Foundation for Surgery of the Hand.
Publisher Copyright:
Copyright © 2017 by the American Society of Plastic Surgeons.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Background: In the debate on reconstruction of the irradiated breast, there is little information on associated health care resource use. Nationwide data were used to examine health care resource use associated with implant and autologous reconstruction. It was hypothesized that failure rates would contribute the most to higher average cumulative cost with either reconstruction method. Methods: From the 2009 to 2013 MarketScan Commercial Claims and Encounters database, irradiated breast cancer patients who underwent implant or autologous reconstruction were selected. In a 24-month follow-up period, the cumulative costs of health care services used were tallied and described. Regression models stratified by reconstruction method were then used to estimate the influence of failure on cumulative cost of reconstruction. Results: There were 2964 study patients. Most (78 percent) underwent implant reconstruction. The unadjusted mean costs for implant and autologous reconstructions were $22,868 and $30,527, respectively. Thirty-two percent of implant reconstructions failed, compared with 5 percent of autologous cases. Twelve percent of the implant reconstructions had two or more failures and required subsequent autologous reconstruction. The cost of implant reconstruction failure requiring a flap was $47,214, and the cost for autologous failures was $48,344. In aggregate, failures constituted more than 20 percent of the cumulative costs of implant reconstruction compared with less than 5 percent for autologous reconstruction. Conclusions: More than one in 10 patients who had implant reconstruction in the setting of radiation therapy to the breast eventually required a flap for failure. These findings make a case for autologous reconstruction being primarily considered in irradiated patients who have this option available.
AB - Background: In the debate on reconstruction of the irradiated breast, there is little information on associated health care resource use. Nationwide data were used to examine health care resource use associated with implant and autologous reconstruction. It was hypothesized that failure rates would contribute the most to higher average cumulative cost with either reconstruction method. Methods: From the 2009 to 2013 MarketScan Commercial Claims and Encounters database, irradiated breast cancer patients who underwent implant or autologous reconstruction were selected. In a 24-month follow-up period, the cumulative costs of health care services used were tallied and described. Regression models stratified by reconstruction method were then used to estimate the influence of failure on cumulative cost of reconstruction. Results: There were 2964 study patients. Most (78 percent) underwent implant reconstruction. The unadjusted mean costs for implant and autologous reconstructions were $22,868 and $30,527, respectively. Thirty-two percent of implant reconstructions failed, compared with 5 percent of autologous cases. Twelve percent of the implant reconstructions had two or more failures and required subsequent autologous reconstruction. The cost of implant reconstruction failure requiring a flap was $47,214, and the cost for autologous failures was $48,344. In aggregate, failures constituted more than 20 percent of the cumulative costs of implant reconstruction compared with less than 5 percent for autologous reconstruction. Conclusions: More than one in 10 patients who had implant reconstruction in the setting of radiation therapy to the breast eventually required a flap for failure. These findings make a case for autologous reconstruction being primarily considered in irradiated patients who have this option available.
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U2 - 10.1097/PRS.0000000000003336
DO - 10.1097/PRS.0000000000003336
M3 - Article
C2 - 28538545
AN - SCOPUS:85019941482
SN - 0032-1052
VL - 139
SP - 1224e-1231e
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 6
ER -