Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back
Rate ePoster

Head and Neck Surgery

(116) Cost Utility Analysis of Reconstruction Options for Oral Cavity Carcinoma

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • David Zachariah Allen, MD

    Resident
    University of Texas Health Science Center At Houston
    Houston, TX, United States

    • Senior Author(s)

  • KJ

    Kunal Jain, MD

    Associate Professor
    The University of Texas Health Science Center At Houston
    Houston , Texas, United States

Disclosure(s):
David Zachariah Allen, MD: No relevant relationships to disclose.
Kunal Jain, MD: No relevant relationships to disclose.


Introduction: Free tissue transfer has revolutionized the clinical course of oral cavity carcinoma patients, allowing for patients to regain near-normal swallow, speech and overall function. However, radial forearm free flaps (RFFF), the prototypical workhorse for free flap reconstruction of medium sized defects of the oral cavity, is associated with significant operating time, prolonged hospitalization and increased trips to the operating room and skilled nursing home utilization. Locoregional flaps such as FAMM flap have equivalent outcomes and less morbidity with reduced healthcare utilization. While there have been some reports dictating institutional comparison of the procedures, there has yet to be a cost utility analysis comparing the two modalities.

Methods: A cost utility analysis was performed in R studio evaluating patients who undergo a RFFF or a FAMM. A markov model and decision model was utilized. The health states were assumed to be: (1) Healthy - No Flap Complications, (2) Flap Complications Requiring Surgery, (3) Flap Complications Not Requiring Surgery but needing skilled nursing facility, and (4) Death. All costs, health utilities, and ranges were found from reported values. The number of quality adjusted life years (QALY) and incremental cost effectiveness analysis (ICER) was tabulated.

Results: For a decision model, the expected cost for the RFFF in total was $40509 compared to $29815 and the average change in QALY was 0.8 for FAMM compared to 0.7 for RFFF. As such, there was a -$10694 change for a 0.1 change in QALY, an ICER of -$106940/QALY and RFFF was strongly dominated by FAMM. In markov model analysis over a five year time period, FAMM was cost effective and probabilistic sensitivity analysis reported a greater than 99% probability of FAMM being a cost-effective strategy for a willingness-to-pay threshold of $50,000/QALY.

Conclusions: In patients amenable to either a FAMM or RFFF, a FAMM procedure is a cost effective strategy.