Cost Utility of Breast Tissue Expansion using Carbon Dioxide versus Saline: An Analysis of Infection Risk

Abstract

Background:The AeroForm System, a needle-free, patient-controlled carbon dioxide-filled tissue expander, represents a novel option for tissue expansion in 2-stage breast reconstruction. This technology has previously been found to decrease time to expansion, health-care utilization, and infection rates. The purpose of this study was to determine the economic impact of the reduced infection rate observed with the AeroForm tissue expander as compared with saline tissue expansion.Methods:A decision model incorporating costs, quality-adjusted life years, and clinical outcomes of infection was designed to evaluate the cost-efficacy of AeroForm tissue expanders versus conventional saline expanders. All statistical calculations were performed in the R statistical computing environment.Results:Pooled infection rates from the published literature following saline and AeroForm tissue expander placement were 5.83% and 2.62%, respectively. Cost-utility analysis resulted in a baseline expected savings of $253.29 and an expected gain of 0.00122 quality-adjusted life years with AeroForm tissue expanders. One-way sensitivity analysis revealed that AeroForm tissue expanders were dominant when the surgical site infection rate was greater than 4.56% with traditional saline expanders.Conclusions:Clinical benefits of an innovation are no longer sufficient to justify its acquisition costs. Novel technologies must also demonstrate favorable economic outcomes. This cost-utility analysis demonstrates that the use of AeroForm expanders is likely a cost-saving technology for 2-stage breast reconstruction.

The Impact of Aeroform Tissue Expanders on the Outcomes of Implant-Based Breast Reconstruction; A Systematic Review and Meta-Analysis

“…Based on the NIH quality assessment tool, there were five articles of good quality and three articles of fair quality. Based on The Drummond Checklist adapted, Chopra et al [ 31 ] fulfilled the criteria for study design and partially fulfilled the criteria related to data collection and analysis and interpretation of results. (Fig.…”

Comparison of nine methods of immediate breast reconstruction after resection of localized breast cancer: A cost‐effectiveness Markov decision analysis of prospective studies

“…This provided the most robust inclusion of studies, screened and graded by the Tufts University CEA Registry for inclusion in cost‐effectiveness studies (Center for the Evaluation of Value and Risk in Health, (CEVR), 2019). Previous cost‐effectiveness studies relied on retrospective studies to derive clinical parameters (Chatterjee et al, 2013; Chatterjee et al, 2015; Chopra et al, 2019; Grover et al, 2013; Krishnan et al, 2013; Krishnan et al, 2014; Offodile et al, 2015; Thoma et al, 2003; Thoma et al, 2004). In the present study, clinical parameters specific to each of the nine methods of breast reconstruction were included only from prospective studies without neoadjuvant or adjuvant radiation.…”

“…Additional costs were added for complications and revisions. Costs of saline ($475/implant) and silicone ($1500/implant) implants, saline tissue expanders ($1700/expander) and supplies ($26), acellular dermal matrices (ADM) ($3411/ADM), indocyanine green (ICG) ($518), fat transfer systems ($526), and polypropylene meshes ($1500/mesh) were estimated from the literature and commercially available industry data (Table 3) (Allergan Inc, 2020a; Allergan Inc, 2020b; Allergan Inc, 2020c; Bioscience, 2019; Chatterjee et al, 2013; Chatterjee et al, 2015; Chopra et al, 2019; Ethicon, 2019; Mentor Worldwide L, 2020; Negenborn et al, 2019). Costs of saline and silicone implants were averaged to approximately $900 for the model.…”

“…Costs included direct payments from healthcare perspectives and indirect payments (lost productivity from time off work, gas prices) added to direct payments from societal perspectives (Nyman, 2018) Chopra et al, 2019;Ethicon, 2019;Mentor Worldwide L, 2020;Negenborn et al, 2019). Costs of saline and silicone implants were averaged to approximately $900 for the model.…”

“…Bilateral breast reconstruction provided greater effectiveness relied on retrospective studies to derive clinical parameters (Chatterjee et al, 2013;Chatterjee et al, 2015;Chopra et al, 2019;Grover et al, 2013;Krishnan et al, 2013;Krishnan et al, 2014;Offodile et al, 2015;Thoma et al, 2003;Thoma et al, 2004). In the (SMDM) Task Force emphasize this analytic approach Husereau et al, 2013;Sanders et al, 2016).…”