Cost-effectiveness analysis parallel to a randomized controlled trial comparing vertical scar reduction and inverted T-shaped reduction mammaplasty.

Abstract

Sir: We read with great interest the results of the important trial comparing cost-effectiveness between vertical and inverted-T breast reductions.1 We congratulate the authors on conducting the first economic evaluation in comparing those two reduction mammaplasty techniques. Because the authors conducted subgroup analysis based on the average weight of the breast resected (<500 g or ≥500 g), related data could be listed to identify whether the subgroup with a mean weight of the breast resected less than 500 g was comparable between the vertical scar reductions and the inverted-T scar reductions. The authors mentioned that one case with infection in the inverted T–shaped reduction group and another case with dog-ear in the vertical scar reduction group required revision surgery. Because the study population was derived from a publicly funded health care system and the cosmetic outcome was not under consideration, it seems that the intervention for the dog-ear was not necessary. Furthermore, it is advisable to wait 1 year before performing any revisions,2 so it might be too early for such a dog-ear revision. We suggest that data on complications would be available with more details, such as the cost for the patients with complications. Theoretically, if the complication occurred in the inverted T–shaped scar reduction group with a breast resection weight of less than 500 g, whereas another complication occurred in the vertical scar reduction group with a breast resection weight of greater than or equal to 500 g, the increased cost of the patient with a complication in the inverted T–shaped scar reduction group with a breast resection weight of less than 500 g might explain why the cost of the procedure for patients in this group was higher than for their counterparts in the vertical scar resection group. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Jiuzuo Huang, M.D. Xiaojun Wang, M.D., Ph.D. Division of Plastic and Reconstructive Surgery Department of Surgery Peking Union Medical College Hospital Beijing, People’s Republic of China