The merits of decision modelling in the earliest stages of the IDEAL framework – an innovative case in DIEP flap breast reconstructions

Publication date: Available online 7 August 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): S. Hummelink, J.G.W. Gerrits, L.J. Schultze Kool, D.J.O. Ulrich, M.M. Rovers, J.P.C. Grutters
BackgroundIDEAL framework aims at improving the evidence base of available surgical innovations. However, the development of such innovations and collection of evidence is costly. Surgical innovation can provide more value for money if innovations are evaluated in an early stage, where evaluations can inform the decision whether to stop or further develop an innovation. We illustrate how decision modelling can be readily adopted at the earliest stages (0-1) of the IDEAL framework, using an innovation in bilateral DIEP flap breast reconstruction as an example.MethodsWe quantified expected costs and quality-adjusted life years (QALYs) of the current treatment and compared this with an innovation aimed at reducing complications and surgery time. The maximum impact of eliminating all complications (headroom analysis) was explored. Second three scenarios with varying complication and surgery time reduction was modeled. Third, the maximum price of the innovation was estimated in a threshold analysis, based on its impact and societal willingness to pay.ResultsThe headroom analysis showed that when all complications associated with current treatment are prevented, up to €889 per patient is saved. Scenario analysis showed cost savings between €256 and €828 per patient. When surgery time is reduced by 15 minutes and complications by 50%, the innovation will remain cost-effective at €671 per patient.ConclusionIn a field struggling with cost containment, decision modelling can help to separate promising innovations from costly failures in an early stage. In this example, decision modelling showed that it seems worthwhile to further develop the innovation.



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