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A Comparison of Acellular Dermal Matrix to Autologous Dermal Flaps in Single-Stage, Implant-Based Immediate Breast Reconstruction: A Cost-Effectiveness Analysis

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

Plastic and Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 953–961
doi: 10.1097/PRS.0b013e3182865a24
Breast: Original Articles
Video Discussion

Background: The use of acellular dermal matrix has allowed for single-stage immediate breast reconstruction after mastectomy at a significantly decreased cost compared with two-stage expander/implant reconstruction. The use of a pedicled autologous dermal flap in the same fashion as acellular dermal matrix in women with larger, ptotic breasts has also allowed for single-stage immediate breast reconstruction with similarly low complication rates and without the added procedural cost of using acellular dermal matrix. There have been no prior studies evaluating whether the added procedural cost for acellular dermal matrix is cost-effective relative to using an autologous dermal flap in single-stage immediate breast reconstruction following mastectomy.

Methods: A comprehensive literature review was conducted to identify published complication rates for single-stage, implant-based immediate breast reconstruction using either acellular dermal matrix or an autologous dermal flap. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes and expert utility estimates to fit into a decision model to evaluate the cost-effectiveness of acellular dermal matrix.

Results: The decision model revealed a baseline cost difference of $261.72 and a 0.001 increase in the quality-adjusted life years when using acellular dermal matrix, yielding an incremental cost-utility ratio of $261,720 per quality-adjusted life year. Sensitivity analysis showed that acellular dermal matrix was not cost-effective when the complication rate for autologous dermal flaps was below 20 percent.

Conclusions: The authors’ study demonstrates that acellular dermal matrix is not a cost-effective technology in patients who can have an autologous dermal flap in single-stage immediate breast reconstruction.

Hanover and Lebanon, N.H.

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

Received for publication September 10, 2012; accepted November 20, 2012.

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

Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, N.H. 03755,

©2013American Society of Plastic Surgeons