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Cost-Effectiveness Analysis Parallel to a Randomized Controlled Trial Comparing Vertical Scar Reduction and Inverted T–Shaped Reduction Mammaplasty

Thoma, Achilleas M.D., M.Sc.; Kaur, Manraj Nirmal M.Sc., P.T.; Tsoi, Bernice M.Sc.; Ziolkowski, Natalia B.Com., M.D.; Duku, Eric Ph.D.; Goldsmith, Charles Harry Ph.D.

Plastic and Reconstructive Surgery: December 2014 - Volume 134 - Issue 6 - p 1093–1107
doi: 10.1097/PRS.0000000000000751
Breast: Outcomes Article

Background: A previous randomized controlled trial showed no clear superiority of vertical scar over inverted T-shaped reduction mammaplasty in terms of health-related quality of life. No economic evaluation has been undertaken comparing vertical scar reduction and inverted T -shaped reduction.

Methods: A total of 255 patients were randomized to either vertical scar or inverted T -shaped reduction. The effectiveness was measured with the Health Utilities Index Mark 3. Direct and productivity costs were captured parallel to the randomized controlled trial. Perspectives of the Ministry of Health, patient, and society were considered.

Results: Inverted T -shaped reduction dominated vertical scar reduction from the Ministry of Health perspective by being slightly less costly ($3090.06 versus $3106.58) and slightly more effective (0.87 quality-adjusted life-years versus 0.86 quality-adjusted life-years). From the societal and patient perspectives, vertical scar reduction was both less costly and less effective. At the commonly quoted Canadian threshold of $50,000 per quality-adjusted life-year gained, the probability that vertical scar reduction was cost-effective was 29.3, 68.2, and 66.9 percent from the Ministry of Health, patient, and societal perspectives. Subgroup analysis of reductions less than 500 g found that vertical scar reduction was more likely cost-effective.

Conclusions: Vertical scar reduction is more likely than not cost-effective from patient and societal perspectives but not from the Ministry of Health perspective at a willingness-to-pay threshold of $50,000 per quality-adjusted life-year. If we limit vertical scar reduction for resections less than 500 g per breast, this technique is more likely cost-effective from all perspectives.

Hamilton and Toronto, Ontario; and Burnaby, British Columbia, Canada

From the Division of Plastic Surgery, Department of Surgery, Department of Clinical Epidemiology and Biostatistics, the Surgical Outcomes Research Center, Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University; Programs for Assessment of Technology in Health Research Institute, St. Joseph’s Healthcare; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto; and Faculty of Health Sciences, Simon Fraser University.

Received for publication December 3, 2013; accepted May 8, 2014.

The trial was registered under the name “Vertical Scar Versus Inferior Pedicle Reduction Mammoplasty,” identification number NCT00149344 (

Presented at the 67th Annual Meeting of the Canadian Society of Plastic Surgeons, in Calgary, Alberta, Canada, May 28 through June 1, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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

©2014American Society of Plastic Surgeons