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Systematic Review of Economic Evaluations in Plastic Surgery

Ziolkowski, Natalia I. B.Com., B.Sc.; Voineskos, Sophocles H. M.D.; Ignacy, Teegan A. B.Sc.; Thoma, Achilleas M.D., M.Sc.

Plastic and Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 191–203
doi: 10.1097/PRS.0b013e318290f8f8
Reconstructive: Trunk: Outcomes Article

Background: Economic evaluations are quantitative methods comparing alternative interventions using cost data and expected outcomes. They are used to recommend/dissuade adoption of new surgical interventions and compare different clinical pathways, settings (inpatient/outpatient), or time horizons to determine which procedure may be more cost-effective. The objective of this systematic review was to describe all published English economic evaluations related to a plastic surgery domain.

Methods: A comprehensive English literature review of the MEDLINE, EMBASE, The Cochrane Library, Health Economic Evaluations Database, Ovid Health Star, and Business Source Complete databases was conducted (January 1, 1986, to June 15, 2012). Articles were assessed by two independent reviewers using predefined data fields and selected using specific inclusion criteria. Extracted information included country of origin, journal, and date of publication. Domain of plastic surgery and type of economic evaluation were ascertained.

Results: Ninety-five articles were included in the final analysis, with cost analysis being the most common economic evaluation (82 percent). Full economic evaluations represented 18 percent. General cutaneous disorders/burns (24 percent), breast surgery (20 percent), and “multiple” (15 percent) were the top domains studied. Authors were predominantly based in the United States (56 percent) and published in the journal Plastic and Reconstructive Surgery (22 percent), with a significant proportion (40 percent) published in the last 5 years.

Conclusions: Partial economic assessments (cost analyses) with limited benefit represent the majority of economic evaluations in plastic surgery. This suggests an urgent need to alert plastic surgeons to the advantages of full economic evaluations (cost-effectiveness and cost utility analyses) and the need to perform such rigorous analyses.

Supplemental Digital Content is available in the text.

Warsaw, Poland; and Hamilton, Ontario, Canada

From the Second Department of General, Vascular, and Oncologic Surgery, Medical University of Warsaw; and the Division of Plastic Surgery and the Surgical Outcomes Research Center, Department of Surgery, and the Department of Clinical Epidemiology and Biostatistics, McMaster University.

Received for publication November 5, 2012; accepted January 17, 2013.

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Poster presented at the 66th Annual Meeting of the Canadian Society of Plastic Surgeons, in Toronto, Canada, June 5 through 9, 2012.

Disclosure: The authors have no conflicts of interest or financial disclosures. No funds were received for the preparation of this article.

Achilleas Thoma, M.D., M.Sc., 101-206 James Street South, Hamilton, Ontario, Canada L8P 3A9,

©2013American Society of Plastic Surgeons