Table 7. Studies comparing cost-effectiveness (ADM versus Non-ADM).
| Reference | Study type | Reconstructions compared | Method | Factors included | Results |
|---|---|---|---|---|---|
| Johnson et al [41], 2013 | Single-centre cohort, retrospective | Strattice: bilateral (n = 13), unilateral (n = 11) TE/I: bilateral n = 12, unilateral n = 10 LD + implant n = 10 |
Use of National Tariffs (NHS England 2011–2012) as a proxy for hospital costs plus acquisition costs for Strattice | Cost of index operation, consumables in addition to those accounted for in-tariff payment, admissions and attendances and complications | For unilateral cases, Strattice is less costlier than TE/I (£3685 vs. £4985) and LD-based reconstructions (£3685 vs. £6321) For bilateral cases, Strattice is costlier than TE/I due to anomaly in reimbursement system where bilateral mastectomy does not attract any higher reimbursement than unilateral |
| Kilchenmann et al [42], 2014 |
Single-centre cohort, retrospective | Unilateral reconstructions only Strattice one-stage n = 25 TE/I n = 27 LD+ implant n = 32 LD/TE n = 17 |
Use of resources utilised rather than costs incurred | Cost of initial operation, additional hospitalisations and operative procedures; outpatient appointments, seroma aspiration, complication rates | Unilateral single-stage ADM reconstructions were associated with fewer resources utilised compared to TE/I and LD/TE/I in both complicated and non-complicated cases over a 24-m period. LD + mplantI and ADM cohorts equivalent |
| Bank et al [43], 2013 | Single-centre, retrospective | Uncomplicated reconstructions only TE/I with ADM (Strattice or Alloderm) n = 84 Non-ADM TE/I n = 48 |
Number of tissue expansions required to meet final fill volume as a proxy for number of outpatient clinic encounters | Total cost of each clinic encounter using expenditure data from centre (faculty fees, labour fees, material costs). Cost of ADM | Although fewer clinic visits are required to achieve final fill volume in ADM cohort the savings made did not offset the cost of using an ADM. Difference of $3000 remained if Alloderm is used and $2500 if Strattice |