Abstract
A decision tree was constructed to determine the incremental cost-effectiveness ratio
(ICER) of grafting techniques used to prevent Frey Syndrome. The authors performed
a sensitivity analysis to calculate what the probability of preventing Frey Syndrome
would have to be and maximum costs associated with using grafting techniques to warrant
their use as more “cost-effective” choice than using neither. Decision pathways utilized
were uses of (1) free fat graft (FFG), (2) acellular dermis, and (3) no grafting.
The probability of developing Frey syndrome and costs were extracted from previous
studies to construct the decision tree. The primary effectiveness was the ICER of
FFG or acellular dermis to prevent Frey syndrome. The initial outcomes included preventing
Frey syndrome (effectiveness = 1) or developing Frey syndrome (effectiveness = 0).
Compared with not using a graft, the ICER of using FFG and acellular dermis were $10,628
and $50,813, respectively. Frey syndrome was found in 2.6% of patients postoperatively
in FFG group, 9.8% of patients in acellular dermis group, and 30.7% of patients who
did not have a graft. The ICER shows absolute dominance of FFG with lower cost and
high effectiveness over acellular dermis. This economic evaluation strongly supports
the use of FFG over acellular dermis as cost-effective approach for prevention of
postparotidectomy Frey syndrome.
Keywords
Frey syndrome - parotidectomy - cost-effectiveness
