Grants We Funded

Abstract

Impact Statement: Breast reconstruction is increasingly popular and expensive. Innovative methods of improving functional and aesthetic outcomes to mitigate the effects of subpectoral implant placement are increasing in popularity. However, little is known regarding the impact of animation deformity on the patient experience and the costs associated with newer technologies and techniques. In this study, we will conduct a cost-effectiveness analysis of these new techniques using patient-reported outcome measures (eg, BREAST-Q animation deformity scale). Detailed cost and resource utilization data will be collected. The results will be used to inform patients, surgeons, and policymakers on the incremental value afforded by newer procedures and assist with decision making and policy implementation.

Project Summary: One in eight women will develop breast cancer in the US. The percentage of women who undergo mastectomy and reconstruction is increasing, and as of 2016, over 40% of women had reconstruction. Implant-based reconstruction (IBR) is the most common type of breast reconstruction and is most commonly performed in the subpectoral plane; however, this approach is associated with increased pain and movement of the implant. Prepectoral implant placement avoids disruption of the chest muscles has made a resurgence in popularity in the United States. This technique is relatively novel, and robust evidence regarding clinical effectiveness and costs is lacking. This proposal seeks to overcome these limitations through a rigorous, prospective study comparing patient-reported outcomes (PROs), clinical outcomes, and cost-effectiveness of prepectoral and subpectoral IBR after mastectomy. The evidence comparing these two procedures is rapidly evolving. What remains unclear is how these two procedures compare from a patient perspective. Patient-reported outcome measures (PROMs) are questionnaires that ask patients how they feel and function. To date, few studies have evaluated prepectoral and subpectoral reconstructions using PROMs, and no study has used an animation deformity-specific PROM. Further, as healthcare costs continue to outpace inflation, the need to justify the financial costs per unit benefit of these procedures is required. The purpose of this study is to conduct a cost-effectiveness analysis of prepectoral and subpectoral IBR. To this effect, we will use established PROMs to assess satisfaction with breasts and animation deformity over 12 months. Additionally, we will perform a micro-costing analysis to accurately ascertain the costs of these two procedures. This data will be combined to determine the cost-effectiveness of the prepectoral and subpectoral approach while identifying patient characteristics associated with high resource utilization and major cost drivers. This proposal is timely as it intersects a time where the incidence of prepectoral reconstruction is expanding rapidly, and emphasis on value and the patient experience is becoming more influential. This will be the first study that prospectively evaluates value by comparing thePROs while accurately measuring costs. The results of this study will be used to inform patients and set expectations preoperatively, ultimately advancing evidence- and value-based decision making.

Biography
Dr. Justin Broyles is a Plastic and Reconstructive surgeon at Brigham and Women’s Hospital and member of the faculty at Harvard Medical School with a strong interest in providing innovative reconstructive solutions for cancer patients. He completed plastic surgery residency at Johns Hopkins Hospital and microsurgical fellowship at MD Anderson Cancer Center. In addition to excellent patient care, he devotes a significant portion of his research endeavors to making surgery safer and more cost-effective. He spends seventy-five percent of his time devoted to clinical practice and twenty-five percent of his time dedicated to clinical outcomes and health services research. Dr. Broyles dedicates a significant portion of his clinical practice to improving functional outcomes in cancer patients and focuses primarily on breast reconstruction. He has written over 45 publications on the topic of reconstructive surgery and given multiple talks at national meetings. He is currently a Masters of Public Health student at the Harvard Chan School of Public Health. Dr. Broyles is involved in the teaching of medical students and residents. As the Harvard Plastic Surgery Site Director, he teaches Harvard trainees on all aspects of surgery. Additionally, he mentors medical students and residents and leads a team from Harvard focusing on various research projects which have generated multiple publications and presentations at national meetings.