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CT angiography cost-effective, decreases operative times for autologous breast reconstruction

Through a review of the available literature, researchers found CT angiography was a cost-effective method for preoperatively identifying lower-abdominal perforators for autologous breast reconstruction.

Using the Medline and Cochrane online databases, the researchers identified six studies with 782 patients that appeared to have the most clinically significant outcomes associated with abdomen-based perforator flap breast reconstruction during which CT angiography was used preoperatively. The researchers used cost and utility estimates for each of three clinically relevant health outcomes to determine patients’ quality-adjusted life-years (QALYs) and incremental cost-utility ratios.

Lifei Guo

Results of the cost-utility analysis demonstrated a baseline cost savings of $3,179, in addition to a gain of 0.25 in QALYs, according to the researchers. With an incremental cost-utility ratio of −$12,716, the researchers found preoperative CT angiography was favored as the dominant choice over Doppler ultrasonography.

Although CT angiography was demonstrated through sensitivity analysis to be the costlier option when operative times were shorter than 21.3 minutes, the clinical advantage of CT angiography over Doppler ultrasonography indicated CT angiography would still be the most cost-effective option regardless of whether there were any additional operating-time advantages revealed, according to the researchers.

Fewer complications were found within the CT angiography procedures, which also helped to provide an overall decreased cost and increased clinical benefit, the researchers reported.

"Our study was prompted by the simple question of which is the "better value" imaging technology for pre-op planning in microvascular breast reconstruction," researcher Lifei Guo, MD, PhD, FACS, told Healio.com/Aesthetics.

"With the ready availability of competing technologies in Doppler and CT-Angiography, current provider practice was driven by institutional bias and personal preference. It seemed to us, that a more objective selection criterion was sorely needed. What we were able to convincingly show in our results was that CT-Angiography represented a more "cost effective" imaging strategy with regards to facilitating free autologous breast reconstruction. This is because it translated to more cost savings for the health care system as well as improved clinical outcomes for the individual patient. We believe that in the future, more and more of the decisions we make as clinicians will be underpinned by "value-based" care," Guo stated. – by Abigail Sutton

Stephan Ariyan, MD, President, American Association of Plastic Surgeons; Lifei Guo, MD, PhD, FACS; Fan Liang, MD, and Anaeze C. Offodile II, MD, at the recently concluded AAPS annual meeting in Scottsdale, where the paper won the resident poster award in the breast reconstruction category. Photo credit: Lifei Guo, MD, PhD, FACS

Disclosure: The researchers report no relevant financial disclosures.