Tuesday, July 16, 2024

Economic Evaluation Reveals Virtual Surgical Planning More Cost-Effective for Mandibular Reconstruction

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A recent study delves into the economic viability of Virtual Surgical Planning (VSP) versus Free Hand Reconstruction (FHR) for advanced oral cavity cancer, highlighting significant cost-effectiveness amid complex clinical considerations. This investigation juxtaposes the clinical benefits of VSP with its initial higher costs, providing an essential analysis for healthcare providers and policymakers on strategic decision-making in advanced oral cancer treatment.

Comparative Analysis of VSP and FHR

The study employed a Markov decision analysis model, leveraging both literature and institutional data over a 35-year period. Parameters were meticulously derived from systematic reviews and institutional experiences. The model incorporated VSP costs and time savings in surgery, while accounting for long-term risks such as cancer recurrence and hardware failure. Cost was measured in US dollars, and effectiveness was evaluated in quality-adjusted life years (QALYs). From a healthcare perspective, costs and effectiveness were discounted at 3% per year, ensuring a comprehensive economic evaluation.

Key Findings and Sensitivity Analysis

Results revealed that the total cost for VSP was $49,498 with an effectiveness of 8.37 QALYs gained, compared to $42,478 and 8.27 QALYs for FHR. The incremental cost-effectiveness ratio (ICER) for VSP was calculated at $68,382 per QALY gained. Interestingly, the favorability of VSP was highly sensitive to patient age at diagnosis and institutional VSP costs. Specifically, VSP was less favorable for patients over 75.5 years or when institutional VSP costs exceeded $10,745. Probabilistic sensitivity analysis demonstrated that in 55% of iterations, the ICER value remained below the $100,000 per QALY threshold, underscoring the nuanced economic viability of VSP.

From a market access perspective, the study underscores the importance of patient selection and institutional cost management in optimizing the adoption of VSP. The nuanced findings suggest that while VSP offers economic advantages, its broader implementation depends on careful consideration of patient demographics and institutional cost structures.

Concrete Inferences

Strategic Insights:

• VSP offers a marginally higher quality-adjusted life year gain compared to FHR.
• Cost-effectiveness of VSP is highly influenced by institutional costs and patient age.
• VSP is a viable option, particularly for younger patients and institutions with optimized cost structures.
• Market access for VSP could be enhanced through targeted strategies focusing on cost management and patient selection criteria.

In conclusion, while VSP shows promising economic benefits over FHR in the treatment of advanced oral cavity cancer, its cost-effectiveness is significantly influenced by patient demographics and institutional costs. This study emphasizes the necessity for careful patient selection to maximize the benefits of VSP, suggesting that younger patients and institutions with lower VSP costs may derive the most value. Further research is needed to better understand the long-term risks associated with hardware failure and exposure in VSP compared to FHR, ensuring comprehensive patient care and optimal resource utilization.

Original Article:

Microsurgery. 2024 Jul;44(5):e31206. doi: 10.1002/micr.31206.

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ABSTRACT

OBJECTIVE: This study is an economic evaluation comparing virtual surgical planning (VSP) utilization to free hand mandibular reconstruction (FHR) for advanced oral cavity cancer, for which the cost effectiveness remains poorly understood. The proposed clinical benefits of VSP must be weighed against the additional upfront costs.

METHODS: A Markov decision analysis model was created for VSP and FHR based on literature review and institutional data over a 35-year time horizon. Model parameters were derived and averaged from systematic review and institutional experience. VSP cost and surgical time saving was incorporated. We accounted for long-term risks including cancer recurrence and hardware failure/exposure. We calculated cost in US dollars and effectiveness in quality-adjusted-life-years (QALYs). A health care perspective was adopted, discounting costs and effectiveness at 3%/year. Deterministic and probabilistic sensitivity analyses tested model robustness.

RESULTS: In the base case scenario, total VSP strategy cost was $49,498 with 8.37 QALYs gained while FHR cost was $42,478 with 8.27 QALY gained. An incremental cost-effectiveness ratio (ICER), or the difference in cost/difference in effectiveness, for VSP was calculated at $68,382/QALY gained. VSP strategy favorability was sensitive to variations of patient age at diagnosis and institutional VSP cost with one-way sensitivity analysis. VSP was less economically favorable for patients >75.5 years of age or for institutional VSP costs >$10,745. In a probabilistic sensitivity analysis, 55% of iterations demonstrated an ICER value below a $100,000/QALY threshold.

CONCLUSIONS/RELEVANCE: VSP is economically favorable compared to FHR in patients requiring mandibular reconstruction for advanced oral cancer, but these results are sensitive to the patient’s age at diagnosis and the institutional VSP cost. Our results do not suggest if one “should or should not” use VSP, rather, emphasizes the need for patient selection regarding which patients would most benefit from VSP when evaluating quality of life and long-term complications. Further studies are necessary to demonstrate improved long-term risk for hardware failure/exposure in VSP compared to FHR.

PMID:38943374 | DOI:10.1002/micr.31206

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