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The Elephant In The Room: The Cost of ADM In Implant-Based Reconstruction
Casey Zhang, BS, Elizabeth Moroni, MD MHA, Brian Chen, MD, Suzanne Coopey, MD, Andrea Moreira, MD FACS
University of Pittsburgh Medical Center
2024-02-01
Presenter: Casey Zhang
Affidavit:
I certify that work on this project represents the original work of the resident and/or medical student.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
The use of acellular dermal matrix (ADM) has transformed implant-based breast reconstruction (IBR). However, in the US healthcare system, it is important to adopt an approach that prioritizes optimal results for our patients: clinical, aesthetic, patient-reported, and financial. This study aims to compare clinical outcomes and costs associated with four widely used types of ADM.
Methods
We performed a retrospective observational study of patients undergoing IBR at a single institution between January 2022-September 2023. Demographic characteristics, ADM type, operative details, and surgical complications were collected. Student's T-tests and chi-square or Fischer's exact tests were used to compare outcomes between groups with p<0.05 considered significant.
Results
A total of 135 patients (228 breasts) were included in this study. Nine (6.7%) patients underwent reconstruction with Alloderm (LifeCell Co., USA), 44 (32.6%) with FlexHD (Ethicon, USA), 29 (21.5%) with P4HB (Galatea Surgical Inc., USA), and 53 (39.3%) with Ovitex (TELABio, USA). 73 patients (54.1%) underwent DTI and 61 (45.2%) underwent staged reconstruction (p=0.04). There was a significant difference in complications requiring re-admission between groups (22.2%, 25.0%, 0%, 18.9%, for Alloderm, FlexHD, Galaflex, and Ovitex, respectively; p=0.045). There was a significant difference in mesh cost ($14,141, $17,034, $5,518, $9,755, respectively; p=0.001). Total net charge and reimbursement was similar between all groups.
Conclusions
The optimal selection of ADM should provide a balance of good cosmesis, low complication rates, low cost, and wide availability. This study suggests that Galaflex has a favorable financial and complication profile, as compared to Alloderm, FlexHD, and Ovitex.
