Cost-Effectiveness Analysis of Immediate Tissue Engineering Bone Graft Versus Fibula-Free Flap Reconstruction for Mandibular Continuity Defects Secondary to Benign Pathology.

Abstract

Background: Tissue engineering (TE) offers a potential alternative to fibula-free flap (FFF) reconstruction and may reduce surgical complexity, hospital stay, and health care costs.

Purpose: The purpose of this study is to estimate and compare the cost-effectiveness of immediate TE and FFF reconstruction.

Study design, setting, sample: This study was designed as a retrospective cohort conducted at the University of Texas Health Science Center at Houston from November 2015 to March 2024. Exclusion criteria included subjects with malignant pathologies, those treated with only a fasciocutaneous graft, cases of osteoradionecrosis, and those with incomplete records.

Predictor variable: The primary predictor variable was the type of reconstruction method, either TE bone grafts or FFF reconstruction.

Main outcome variables: The main outcome variable was cost-effectiveness which was defined as cost per successful reconstruction. Successful reconstruction was defined as complete union more than 1 year postoperatively without the need for revision surgery and the absence of postoperative complications requiring take-back surgery.

Covariates: Covariates include age, sex, defect size, and American Society of Anesthesiologists classification.

Analyses: R statistical software was used for data analysis. Statistical significance was defined as P < .05.

Results: The sample was composed of 31 subjects with a mean age of 44.97 ± 18.46 years for TE and 41.93 ± 18.23 years for FFF (P = .7). There were 18 (58%) and 13 (42%) subjects in TE and FFF, respectively. The proportion of successful reconstructions was 95% (n = 18) for TE and 77% (n = 13) for FFF (P = .6). The mean total hospital charges for TE were $247,172 ± $54,080 (P < .001) and $423,008 ± $59,571.75 (P < .001) for FFF. The cost per successful reconstruction was $261,711.64 for TE and $549,910.40 for FFF.

Conclusions and relevance: TE may be a more cost-effective alternative to FFF, providing comparable reconstructive success with reduced cost, surgical time, and hospital resource utilization.