Poster: An Analysis of the Plastic Surgery Cost-Utility Literature Using a Novel Scoring Tool

Purpose:

Already common in medicine, cost-utility studies are gaining traction within plastic surgery, given their capability of objectively comparing treatment options and assessing the societal costs of increasing a patient's quality of life.  Through the creation of a scoring tool, we hope to provide a framework to facilitate the creation of rigorous cost-utility studies.  Such studies can help physicians and society better understand the benefits that plastic surgery delivers for patients.  Furthermore, evaluating previous publications with the scoring tool identifies areas for improvement.

Methods:

After reviewing the broader cost-utility literature, we combined the Recommendations from the Panel on Cost Effectiveness in Health and Medicine with needs specific to plastic surgery to create a scoring tool for cost-utility studies (1).  All components necessary to calculate rigorous cost-utility data were included.  A Medline search up to October 2012 was conducted for plastic surgery utility studies in English.  Articles were screened for inclusion criteria, which were 1) publications about plastic surgery topics that 2) used utility measures. 

Results:

A scoring tool with 4 categories of criteria was designed: utility measurements, cost measurements, data adjustments, and best practices.  18 criteria were selected, with each criterion being worth 1 point (Figure 1).  37 publications were identified. Their average total score was 5.6 out of 18 points (Range 2-11 points, Figure 2). 16 studies (43%) measured patient preferences, while 10 (27%) compared patient perspectives with control population samples. Only 7 studies (19%) prospectively measured utility scores over time.   15 studies (41%) measured costs, but only 4 studies included indirect costs.  5 studies (14%) appropriately applied discount rates to calculate the value of treatments over time.  16 studies (43%) used outcomes modeling in final calculations.

Conclusions:

These 37 studies provide an early perspective of what is possible, yet their evaluations using the scoring tool highlight opportunities for improvement across the 4 criteria categories.  Using the scoring tool, future cost-utility studies can more easily address the deficits across each of the categories, resulting in more rigorous and useful cost-utility studies.  The data captured can better inform our decisions in ways that maximize societal impact, improve resource allocation, and allow for more objective decisions regarding elective procedures.

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Figure 2: