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An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps
Published on: December 5, 2025
Accurately costing unilateral delayed DIEP flap breast reconstruction
J T Paget1, K C Young, S M Wilson
1Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol BS16 1LE, United Kingdom. paget_j@hotmail.com
Summary
Free flap breast reconstruction costs are accurately estimated, but reimbursement needs adjustment. Personnel costs are high, prompting efficiency improvements in DIEP procedures.
Area of Science:
- Plastic Surgery
- Health Economics
Background:
- Free flap breast reconstruction is a standard procedure in the UK, integral to breast cancer treatment guidelines.
- While patient outcomes are positive, concerns exist regarding the financial sustainability of these procedures under current reimbursement systems.
Purpose of the Study:
- To compare the actual treatment costs of DIEP (Deep Inferior Epigastric Perforator) breast reconstructions with hospital financial estimates and existing reimbursement tariffs.
- To identify key cost drivers and inform future financial planning and efficiency improvements.
Main Methods:
- A prospective costing analysis of 10 delayed unilateral DIEP breast reconstructions was performed.
- Costs were compared against the hospital's internal financial estimates and historical Health Resource Group (HRG) tariffs for 27 similar cases.
Main Results:
- The mean actual cost of a DIEP procedure was £7628, closely aligning with the financial department's estimate of £8072.
- The existing HRG tariff (£8792) provided adequate reimbursement, resulting in an average net income of £720 per case.
- Personnel costs constituted the largest expenditure, averaging 73% of the total treatment cost.
Conclusions:
- Hospital financial estimates accurately reflect DIEP procedure costs.
- The current HRG code offers sufficient reimbursement, but the new 2012-13 code (HRG JA14z) significantly reduces reimbursement to £7012, requiring attention.
- Identifying personnel costs as the primary expense enabled the implementation of efficiency-enhancing changes.
