Iliac crest free flap versus fibula free flap for mandibular reconstruction: Cost-effectiveness analysis in a Chinese population

Mandibular reconstruction is vital in oral and maxillofacial surgery to restore aesthetics and function after tumor resection or trauma. The iliac crest-free flap (ICFF) and fibula-free flap (FFF) are widely used, but their cost-effectiveness and impact on quality of life (QoL) are debated. A retrospective study of 142 patients (2012-2018) compared ICFF and FFF, analyzing direct costs (surgical, medication, hospitalization) and indirect costs (surgery duration, hospital stay). QoL was assessed using the UW-QOL questionnaire, and incremental cost-effectiveness ratios (ICER) were calculated. ICFF patients had shorter surgery times (370.47 ± 10.02 vs. 481.59 ± 115.77 min, P < 0.01) and lower hospitalization costs ($11,992.77 ± 2130.24vs.$14,294.74 ± 2976.95, P < 0.001). ICFF showed better QoL in appearance and emotional domains, while FFF performed slightly better in salivary function and swallowing. ICER analysis confirmed ICFF as more cost-effective, with superior QoL outcomes. ICFF is ideal for younger patients with moderate defects, offering shorter stays and improved mood-related QoL, whereas FFF is preferred for large defects. Tailored decisions based on defect type, age, and expected outcomes can optimize satisfaction and resource use.