Cost-effectiveness of cranial implants compared with autologous bone grafts

Abstract

Introduction: Autografts are considered more cost-effective than cranial implants due to the use of the patient's own bone. However, autografts are associated with a higher revision surgery rate because of their intrinsic risk of resorption. As revision surgeries imply additional hospital stays and therefore higher costs, autografts may be less cost-effective than cranial implants. Research question: To analyze the cost-effectiveness of cranial implants compared with autografts. Material and methods: We performed a retrospective cohort study of patients who underwent cranioplasty between 2014 and 2020. We collected data on the costs of cranioplasty using each patient's diagnosis and treatment combination (DBC) code. We used the incremental cost-effectiveness ratio (ICER) to assess cost-effectiveness, which was calculated as the ratio of incremental cost and incremental effect of using a cranial implant instead of an autograft. Results: A total of 168 patients were included (mean age 43.0 ± 20.0 years). The median cost of the first cranioplasty procedure was €6249.37 (IQR €5250.64 – €8551.36) for cranial implants and €6261.36 (IQR €5189.14 – €7792.10) for autografts (p = 0.094). The median total cost of all health care related to the cranioplasty procedure was €6460.64 (IQR €6039.68 – €9533.03) for cranial implants and €12,075.01 (IQR €6409.63 – €16,420.71) for autografts (p < 0.001). The ICER of cranial implants compared with autografts was –€7663.22 per revision surgery avoided. Discussion and conclusion: This study found that the use of cranial implants is at a lower cost and more clinically effective than the use of autologous bone grafts.