Introduction: Breast reconstruction, involving highly specialised medical teams, multiple operations and tight follow-up, has a considerable impact on the health system.
Considering present concerns about healthcare costs, and the lack of evidence and published articles on breast reconstruction costs in Switzerland, we retrospectively investigated charges to the Swiss healthcare system for different breast reconstruction procedures at the Centre Hospitalier Universitaire Vaudois. Data have been statistically analysed and discussed.
Method We selected all hospitalized patients in the Reconstructive Surgery unit at the University Hospital of Vaud in Switzerland (CHUV) who underwent a “total” breast reconstruction, meaning from main intervention following total mastectomy to nipple reconstruction and tattoo, from January 2012 to December 2015. Analysis included 76 women who underwent both autologous or implant based reconstructions. Four breast reconstruction techniques were included: Deep Inferior Epigastric Perforator (DIEP) autologous flap reconstruction, Tissue Expender followed by Implant (TE/I), pedicled Latissimus Dorsi (LD) flap with or without tissue expander and implant (LD +/- TE/I).
Costs of the different procedures, as well as the number of required operations, the total operation time, and the duration of the main surgeries were statistically compared.
Results Global costs for DIEP reconstruction were 29'728 ± 1'892 CHF (ave ± Std. Error of Mean), while TE reconstruction showed a significantly higher global cost, reaching an average of 44'313 ± 5'553 CHF (ave ± Std. Error of Mean). LD showed a similar cost, comparing to the DIEP (29'813 ± 3637 CHF), rising when including an implant (37’688 ± 4'840 CHF). Despite a significantly longer operation time, DIEP flap resulted to be significantly cheaper than TE/I. No significant differences in the number of interventions were detected.
Conclusion These data show that, at least according to the swiss insurance system refunds, the intervention with the best cost-benefit ratio is DIEP, considering its lower rate of complications and lower overall costs. Implant-based reconstructions show, a greater likelihood of complications and re-intervention, globally creating superior costs when compared to autologous reconstructions.