Cost-Effectiveness Analysis of Silicone vs. Saline Implant-Based Breast Reconstruction Using the BREAST-Q

Background: The most common type of breast reconstruction is implant-based breast reconstruction. Implant type has been reported to impact quality of life outcomes. Therefore, we sought to evaluate the cost-effectiveness of saline implants versus silicone. Methods: We retrospectively reviewed data from patients who underwent breast reconstruction with saline or silicone implants at our institution. This included type of procedure, Acellular Dermal Matrix (ADM) use, complications, and number of revisions. Costs were estimated using the Center for Medicare and Medicaid Services physician fee schedule and hospital costs. Effectiveness was measured using Breast-Q-adjusted life years (Breast-QALY), a measure of years of perfect breast health, based on Breast-Q data collected before mastectomy and reconstruction and at 12-months after final reconstruction. The incremental cost-effectiveness ratio (ICER) was obtained for silicone and saline reconstruction. Results: We identified 134 women, among which 77 (57%) underwent silicone and 57 (43%) underwent saline breast reconstruction. The cost of saline reconstruction was $1,288.23 less compared to silicone. Breast-QALYs were 28.11 for saline versus 23.57 for silicone, demonstrating higher cost-effectiveness for saline. The ICER for saline was (-)$283.48, or $283.48 less per year of perfect breast-related health post-reconstruction than silicone. Conclusion: Our results indicate that saline breast reconstruction may be more cost-effective compared with silicone at 12 months post-final reconstruction. Silicone was both more expensive and less effective than saline. However, given the relatively small cost difference, surgeon and patient preference may be important in determining type of implant used. Financial Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Funding: None. Presentations: The study was presentated at the annual meeting of the American Society of Reconstructive Microsurgery (January 13-16, 2018, Phoenix, AZ) and was accepted for presentation at the American Society of Breast Surgeons (May 2-6, 2018, Orlando, FL). Ethical Approval: This study was approved by the Johns Hopkins Medicine Institutional Review Board under protocol #IRB00046361. This study conforms to the Declaration of Helsinki ethical principles for medical research. Corresponding author: Carisa M. Cooney, MPH, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287, Email: Ccooney3@jhmi.edu, Phone: 443-287-4629 ©2018American Society of Plastic Surgeons

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