“Cost-Effectiveness Analysis of Virtual Surgical Planning in Mandibular Reconstruction.”

Background: Due to the complex nature of osteocutaneous free flap mandibular reconstruction, modern technologies, such as Virtual Surgical Planning (VSP), have become popularized to refine the procedure. Compared with usual care, VSP has been suggested to reduce operative time and improve accuracy of postoperative reconstructive outcomes. The aim of this study is to examine the cost-effectiveness of virtual surgical planning versus usual care in mandibular reconstruction. Methods: A decision-analytic model was constructed to comparatively understand cost-effectiveness of VSP and usual care treatments based on additional costs of VSP, and costs attributed to probabilities of post-operative complications. Model structure was informed through qualitative clinical interviews from University of North Carolina (UNC) at Chapel Hill, and supported through UNC-Chapel Hill clinical data and literature. Costs and complication probabilities were estimated from the literature. Sensitivity analyses of all uncertain model parameters were performed, and distributional parameters selected based on best practices. Results: Results of base-case analysis indicated that VSP was more costly compared to usual care by a difference of US $7,099 per person. In addition, VSP did not reduce the risk of complications or flap loss. VSP cases had an increased incidence of flap loss by 0.6% and an increased incidence of mandibular infection by 6.5%. Conclusions: VSP has upfront expenses that do not necessarily translate into downstream reduction in complications or improved outcomes. Clinical decision-makers would benefit from future research to identify thresholds whereby VSP may result in more cost-savings for particular types of patients. Financial Disclosure Statement: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Presented at: North Carolina Society of Plastic Surgeons Annual Meeting; Charleston, SC. November 2016. Corresponding author: Jeyhan S. Wood, MD, Division of Plastic and Reconstructive Surgery, 7033 Burnett-Womack Bldg, CB 7195, Chapel Hill, NC 27599-7195, jeyhan_wood@med.unc.edu ©2019American Society of Plastic Surgeons

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