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J Reconstr Microsurg 2023; 39(03): 221-230
DOI: 10.1055/s-0042-1755260
Original Article

The Cost Utility of Virtual Surgical Planning and Computer-Assisted Design/Computer-Assisted Manufacturing in Mandible Reconstruction Using the Free Fibula Osteocutaneous Flap

David E. Kurlander 
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Patrick B. Garvey
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Rene D. Largo
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Peirong Yu
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Edward I. Chang
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Matthew M. Hanasono
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
,
Alexander F. Mericli
1   Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract

Background The use of virtual surgical planning and computer-assisted design and computer-assisted manufacturing (CAD/CAM) has become widespread for mandible reconstruction with the free fibula flap. However, the cost utility of this technology remains unknown.

Methods The authors used a decision tree model to evaluate the cost utility, from the perspective of a hospital or insurer, of mandible reconstruction using CAD/CAM relative to the conventional (non-CAD/CAM) technique for the free fibula flap. Health state probabilities were obtained from a published meta-analysis. Costs were estimated using 2018 Centers for Medicare and Medicaid Services data. Overall expected cost and quality-adjusted life-years (QALYs) were assessed using a Monte Carlo simulation and sensitivity analyses. Cost effectiveness was defined as an incremental cost utility ratio (ICUR) less than the empirically accepted willingness-to-pay value of $50,000 per QALY.

Results Although CAD/CAM reconstruction had a higher expected cost compared with the conventional technique ($36,487 vs. $26,086), the expected QALYs were higher (17.25 vs. 16.93), resulting in an ICUR = $32,503/QALY; therefore, the use of CAD/CAM in free fibula flap mandible reconstruction was cost-effective relative to conventional technique. Monte Carlo sensitivity analysis confirmed CAD/CAM's superior cost utility, demonstrating that it was the preferred and more cost-effective option in the majority of simulations. Sensitivity analyses also illustrated that CAD/CAM remains cost effective at an amount less than $42,903 or flap loss rate less than 4.5%.

Conclusion This cost utility analysis suggests that mandible reconstruction with the free fibula osteocutaneous flap using CAD/CAM is more cost effective than the conventional technique.

Keywords

computer-assisted design and computer-assisted manufacturing - CAD/CAM - fibula flap - mandibulectomy - cost utility

Supplementary Material



Publication History

Received: 31 January 2022

Accepted: 29 May 2022

Article published online:
21 August 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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