Resource utilization and cost analysis of breast reconstruction after mastectomy with temporary versus permanent expanders from the perspective of the Brazilian Private Health System

Abstract

Objective: To estimate direct medical costs associated with breast reconstruction surgery after mastectomy in single stage with permanent expander (BeckerTM expander) versus two stage reconstruction with a temporary expander followed by a silicone implant, from the perspective of the private health care system. Methods: A systematic literature review and an expert panel were conducted to estimate and validate patterns of treatment for both techniques in a 12 month time horizon. Total costs for each procedure and budget impact analysis were calculated. One-way sensitivity analyses were conducted to test temporary expander, silicone implant and permanent expander prices according to brand and applied discounts on full price. Results: Costs of two stage and single stage reconstruction were 14,845 BRL and 14,342 BRL, respectively. Single stage reconstruction exhibited savings of 502 BRL in the base case and 2,482 BRL when a 30%** discount was applied within one-way sensitivity analysis. Budget impact analysis calculated to a private health plan with 1,000,000 patients resulted in savings of 41.825 BRL. Conclusions: Breast reconstruction in single stage showed lower cost when compared to two stage reconstruction.