173. The Rise Of Acellular Dermal Matrix: Cost Consciousness, Industry Payments, And Publication Productivity

Abstract

PURPOSE: Acellular dermal matrix (ADM) has become commonplace in reconstructive surgery. It is estimated to be used in nearly half of all alloplastic breast reconstructive procedures in the US and has been the focus of approximately 500 plastic surgery publications since its adoption. However, ADM is yet to be FDA approved for breast reconstruction, and remains costly compared to potentially noninferior alternatives such as synthetic mesh and autologous reconstruction. An aim of this investigation was to describe external factors associated with the rise of ADM usage over the past two decades in plastic surgery. Attention was paid to report individual ADM-related academic output and correlation with industry funding or public interest in the costs of plastic surgery. METHODS: All PubMed indexed studies focusing on ADM, in eleven plastic surgery journals, were included (n=534). Data on industry funding to the 17 authors with five or more first and last author publications were extracted from the Open Payments Database. The 125 publications from the top 17 authors were reviewed for disclosure of funding and specific study type. To measure public interest, Google Trends in “plastic surgery cost” and “breast surgery cost”-related searches were queried. Relationships between publication quantity, author industry funding, author disclosure rate, and public interest were analyzed by Pearson’s Correlation and linear regression. RESULTS: ADM-focused studies were published at an approximate rate of 4/year from 2000-09 with a precipitous peak to 71 publications in 2012 and subsequent normalization to approximately 36/year. The 17 most-published authors produced eight qualifying publications on average [5-17]. These individuals grossed a total of $19million industry dollars overall with $17M (89%) in non-consulting compensation from ADM-producing companies (NC-ADM).Median/quartile individual total compensation and NC-ADM compensation were $194K/$320K/$1.25M and $17K/$210K/$1.1M respectively. These variables showed strong correlation with individual publication rate [r=0.662 & r=0.647, (p<0.01*)] with a linear regression coefficient of $110K per NC-ADM publication (p< 0.01*). Authors disclosed funding in a mean of 65 ± 26% of their work with a strong correlation between disclosure rate and NC-ADM (r=0.576, p=0.02*). Google trends for searches regarding “breast surgery cost” increased significantly with time (r = 0.822, p <0.001*) and were in strong correlation with ADM-related publications (r=0.671, p<0.01*). CONCLUSION: This study demonstrates significant correlations between ADM-related publications, industry funding, funding disclosure, and public interest. Education in the potential for such relationships and the importance of objectivity in operative protocol design is necessary. Continued analysis for potential biases in evidence and transparency in publication are critical when adopting new techniques and technology.