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Comparative Cost-Effectiveness of Cranioplasty Implants.

Adam Binhammer¹, Josie Jakubowski¹, Oleh Antonyshyn^1,2

¹Department of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Plastic Surgery (Oakville, Ont.)

|February 29, 2020

Summary

Manually shaped titanium mesh offers the most cost-effective cranioplasty for small defects. While autogenous bone or titanium mesh suits larger defects, PMMA and PEEK implants are significantly more expensive.

Keywords:

PEEK PMMA autogenous bone cost cranioplasty operative time titanium implants

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Area of Science:

Neurosurgery
Medical Device Materials
Health Economics

Background:

Cranioplasty is a surgical procedure to repair skull defects.
Material choice impacts operative duration and hospital costs.
Evaluating cost-effectiveness of various cranioplasty implants is crucial for clinical decision-making.

Purpose of the Study:

To compare operative duration and total hospital costs for elective cranioplasty using diverse materials.
Materials evaluated include autogenous bone graft, titanium mesh (manually shaped and custom), PMMA, and PEEK.

Main Methods:

Retrospective chart review at a single center.
Data collected: patient demographics, defect characteristics, operative time, and hospital stay.
Cost data standardized to 2014-2015; bivariate and multivariate analyses performed.

Main Results:

Autogenous implants showed longer operative time (178 min) than manual titanium (P < .01).
Manual titanium cost: $18,335; custom titanium: $31,956; PMMA: $20,786; autogenous: $14,291; PEEK: $27,379 (P = .013).
PMMA and PEEK implants incurred significantly higher costs than manual titanium (P < .01).

Conclusions:

Manually shaped titanium mesh is the most cost-effective for small cranial defects.
Autogenous bone or titanium mesh is best for large or complex defects (e.g., frontal paranasal sinus).
PMMA and PEEK implants are significantly more costly, potentially due to higher complication rates.