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A Comparison of Free Autologous Breast Reconstruction with and without the Use of Laser-Assisted Indocyanine Green Angiography: A Cost-Effectiveness Analysis

Chatterjee, Abhishek M.D., M.B.A.; Krishnan, Naveen M. B.S., M.Phil.; Van Vliet, Michael M. M.D.; Powell, Stephen G. B.A., M.S., Ph.D.; Rosen, Joseph M. M.D.; Ridgway, Emily B. M.D.

Plastic & Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 693e–701e
doi: 10.1097/PRS.0b013e31828659f4
Breast: Outcomes Article

Background: Laser-assisted indocyanine green angiography is a U.S. Food and Drug Administration–approved technology used to assess tissue viability and perfusion. Its use in plastic and reconstructive surgery to assess flap perfusion in autologous breast reconstruction is relatively new. There have been no previous studies evaluating the cost-effectiveness of this new technology compared with the current practice of clinical judgment in evaluating tissue perfusion and viability in free autologous breast reconstruction in patients who have undergone mastectomy.

Methods: A comprehensive literature review was performed to identify the complication rate of the most common complications with and without laser-assisted indocyanine green angiography in free autologous breast reconstruction after mastectomy. These probabilities were combined with Medicare Current Procedural Terminology provider reimbursement codes (cost) and utility estimates for common complications from a survey of 10 plastic surgeons to fit into a decision model to evaluate the cost-effectiveness of laser-assisted indocyanine green angiography.

Results: The decision model revealed a baseline cost difference of $773.66 and a 0.22 difference in the quality-adjusted life-years, yielding an incremental cost-utility ratio of $3516.64 per quality-adjusted life year favoring laser-assisted indocyanine green angiography. Sensitivity analysis showed that using laser-assisted indocyanine green angiography was more cost-effective when the complication rate without using laser-assisted indocyanine green angiography (clinical judgment alone) was 4 percent or higher.

Conclusions: The authors’ study demonstrates that laser-assisted indocyanine green angiography is a cost-effective technology under the most stringent acceptable thresholds when used in immediate free autologous breast reconstruction.

Lebanon and Hanover, N.H.

From the Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center; the Geisel School of Medicine at Dartmouth; and the Tuck School of Business at Dartmouth.

Received for publication August 6, 2012; accepted November 5, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, N.H. 03766, abhishek.chatterjee@hitchcock.org

©2013American Society of Plastic Surgeons