Economic viability of_autologous_breast_reconstruction_final

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Economic viability of_autologous_breast_reconstruction_final

  1. 1. Pouria Moradi Alexander Hills Duncan Atherton Simon WoodCharing Cross Hospital, London ASC, Perth 2010
  2. 2. Aims• Assess the financial implications of breast reconstruction• Establish whether the current gold standard of DIEP is economically viable
  3. 3. Materials and methods• Retrospective audit of: – Procedure – Length of stay – Reconstructive amendments/corrections – Cost• For 1 surgeon, at 1 unit, between 2000-07
  4. 4. • Review of surgical diaries cross referenced against electronic patient records
  5. 5. Results• 274 patients• Average age 48 years• 278 primary breast reconstructions• 366 secondary procedures• Minimum of 1 year follow up• Mean 3 year follow up
  6. 6. Total number and type of breast reconstruction
  7. 7. Breast reconstruction type vs Length of stay (days) Mean MedianCost per £1,183 £2,475 £2,888 £ 2,200Median LOS
  8. 8. Overall mean number of revisions per breast reconstruction
  9. 9. Total number of secondary procedures conducted Implant Symmetrisation Wound care
  10. 10. Total number of secondary procedures conducted Implant Symmetrisation Wound care
  11. 11. What is the tariff for each procedure?
  12. 12. What is the tariff / income for each procedure?
  13. 13. Tariff for additional procedures
  14. 14. What are the financial implications of the additional procedures?
  15. 15. What is the actual cost? THEATRE TIME• Half day list £3200 » Anaesthetic consultant » ODP Nurse (Band 6) » Theatre nurses (Band 6) » Theatre nurse HCA (Band 2) » Recovery Nurse (Band 6) » A&C Support » Limited non pay consumables• So a DIEP/TRAM on a full list - £6400• LD and implant - £3200• Implant reconstruction - £1700
  16. 16. What other costs?• In patient stay (£275 per night)• DIEP/TRAM - 19 hours of one to one nursing - £253 (vs £600 for ITU)• OPD attendances (New £152, FU £78)• (Mastectomy)• LD/Implants - Prosthesis – (£250 – £700)
  17. 17. Financial Summary
  18. 18. Tariff Disparity• Paid solely for the principle procedure• Separately the mastectomy tariff is £2623 and axillary surgery £2549 (Total £5172) – In 2009-10 with HRG4 coding it will vary from £5132-7015 – As not coded - no research grant for masectomy (£480)• Immediate reconstruction financially discouraged
  19. 19. Data Summary
  20. 20. Conclusions• Our belief that autologous reconstruction offers better symmetry at 4-5 years• Weight change impact on symmetry greater with implants• Minimal number of procedures – Autologous less secondary procedures than Implants – Socio-economic costs related to repeat operations
  21. 21. Conclusions
  22. 22. Conclusions• Tariff system does not encourage immediate or bilateral reconstruction

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