Is Banning Texturized Implants to Prevent Breast Implant-Associated Anaplastic Large Cell Lymphoma a Rational...

Area of Science:

• Plastic Surgery
• Oncology
• Health Economics

Background:

• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a growing concern linked to textured breast implants.
• Increased safety concerns are driving global restrictions on textured implants.
• Smooth implants are proposed as an alternative, but their cost-effectiveness and implications are not well understood.

Purpose of the Study:

• To determine the cost-effectiveness of using smooth implants versus textured implants for breast augmentation surgery.
• To evaluate the economic impact of switching from textured to smooth implants in light of BIA-ALCL risks.

Main Methods:

• A decision tree model was employed to assess cost-effectiveness.
• Data for the model were sourced from published literature, including a meta-analysis for capsular contracture (CC) rates.
• Effectiveness was measured by life years, avoided BIA-ALCL cases, avoided deaths, and avoided reoperations.

Main Results:

• The incremental cost for smooth implants to avoid BIA-ALCL was substantial ($18,562,003).
• The incremental cost-effectiveness ratios for life years, avoided death, and avoided reoperations were negative.
• Sensitivity analysis indicated smooth implants are cost-effective for BIA-ALCL prevention only under specific high-risk scenarios (BIA-ALCL risk ≥ 1:196) and low CC rates (≤ 0.096).

Conclusions:

• The use of smooth implants solely to prevent BIA-ALCL is not economically viable.
• Banning textured implants may lead to unintended consequences, including higher rates of capsular contracture and increased reoperations with smooth implants.