Pouria MoradiAlexander Hills

Duncan Atherton Simon Wood

Charing Cross Hospital, London

ASC, Perth 2010

Aims

• Assess the financial implications of breast reconstruction

• Establish whether the current gold standard of DIEP is economically viable

Materials and methods• Retrospective audit of:

– Procedure – Length of stay– Reconstructive amendments/corrections– Cost

• For 1 surgeon, at 1 unit, between 2000-07

• Review of surgical diaries cross referenced against electronic patient records

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

Total number and type of breast reconstruction

Breast reconstruction type vs Length of stay (days)

Cost per Median LOS £1,183 £2,475 £2,888 £ 2,200

Median

Mean

Overall mean number of revisions per breast reconstruction

Total number of secondary procedures conducted

Implant

Symmetrisation

Wound care

Total number of secondary procedures conducted

Implant

Symmetrisation

Wound care

What is the tariff for each procedure?

What is the tariff / income for each procedure?

Tariff for additional procedures

What are the financial implications of the additional procedures?

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

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)

Financial Summary

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

Data Summary

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

Conclusions

Conclusions

• Tariff system does not encourage immediate or bilateral reconstruction