Cost-effectiveness of prophylactic absorbable antibiotic cement for breast implant infection: A break-even analysis

Infection following prepectoral tissue expander (TE) reconstruction is challenging with reported rates between 10-15%. Traditional conservative management of significant TE infections includes intravenous antibiotics and explantation leading to delayed final breast reconstruction. Local delivery of antibiotics with absorbable calcium-sulfate cement following TE reconstruction recently has been shown to reduce TE infection rates. However, the cost-effectiveness of absorbable antibiotic cement routinely during breast reconstruction remains unclear. The purpose of this study is to evaluate and model infection rates, treatment costs, and pricing to determine the break-even threshold for prophylactic antibiotic cement placement. Absolute risk reduction (ARR) and number needed to break even (NNBE) were calculated across a range of infection rates and treatment costs. Using institutional cement cost of $1075 (USD), an estimated 10% infection rate, and an average $13,000 (USD) for an infection event, prophylactic cement becomes cost-effective when baseline infection rates exceed 8.3%, when infection management costs surpass $10,750, or when calcium-sulfate pricing remains below $1300. Non-selective prophylactic use may be economically justified under commonly reported clinical conditions and become even more favorable in settings with higher treatment costs or modestly lower cement pricing. A break-even analysis may be a valuable tool for evaluating infection-prevention strategies in TE-based reconstruction.