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The Optimal Length of Stay after Microvascular Breast Reconstruction: A Cost-Utility Analysis
Alexander F Mericli1, Jesse C Selber1, Rene D Largo1
1From the Department of Plastic Surgery, Division of Surgery, The University of Texas M. D. Anderson Cancer Center.
Background:
Length of stay can have a large impact on overall surgical costs. Several studies have demonstrated that a shortened length of stay is safe and effective after microvascular breast reconstruction. The optimal length of stay from a cost-utility perspective is not known.
Methods:
The authors used a decision tree model to evaluate the cost-utility, from the perspective of the hospital, of a variety of length-of-stay strategies. Health state probabilities were estimated from an institutional chart review. Expected costs and quality-adjusted life-years were assessed using Monte Carlo simulation and sensitivity analyses.
Results:
Over a 10-year period, the authors' overall flap loss and take-back rates were 1.6 percent and 4.9 percent, respectively. After rollback, a 3-day length of stay was identified as the most cost-effective strategy, with an expected cost of $41,680.19 and an expected health utility of 25.68 quality-adjusted life-years. Monte Carlo sensitivity analysis confirmed that discharge on postoperative day 3 was the most cost-effective strategy in the majority of simulations when the willingness-to-pay threshold varied from $50,000 to $130,000 per quality-adjusted life-year gained.
Conclusion:
This cost-utility analysis suggests that a 3-day length of stay is the most cost-effective strategy after microvascular breast reconstruction.
