The Use of Cost-effectiveness Analysis in Plastic Surgery Clinical Research Achilleas Thoma, MD, MSc, FRCS(C), FACS a,b,c, *, Nick Strumas, MD, FRCSC b , Gloria Rockwell, MD, MSc, FRCSC d , Leslie McKnight, MSc b Over the past 2 decades, there have been pressures to control health care spending in many jurisdic- tions. The term, ‘‘cost effective,’’ increasingly is in common parlance. In 1993, the United States Public Health Service convened a Panel on Cost-effective- ness in Health and Medicine. One of the mandates of the panel was to reach a consensus on how to per- form cost-effectiveness analysis (CEA) and help those performing such studies to improve their quality and encourage their comparability [1]. This article reviews the principles underpinning economic evaluations and how they can be applied to plastic surgery. Illustrative examples are drawn from economic evaluations published by the authors. Plastic surgery as a specialty is prolific in the intro- duction of new techniques, procedures, and approaches to solving specific problems. For example, in autologous breast reconstruction, there are various techniques to create a new breast. Con- sidering just one donor flap site, such as the abdo- men, there are several flaps that can be used, including the pedicled transverse rectus abdominis myocutaneous (TRAM) flap, free TRAM flap, deep inferior epigastric perforator (DIEP), muscle sparing TRAM flap, and superficial inferior epigastric artery (SIEA). Every time one of these flaps is used, re- sources are used, in terms of personnel, equipment, facilities, and time. The choice of using one CLINICS IN PLASTIC SURGERY Clin Plastic Surg 35 (2008) 285–296 a Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Health Sciences Centre, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada b Department of Surgery, Division of Plastic Surgery, McMaster University, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON L8N 486, Canada c Surgical Outcomes Research Centre (SOURCE), McMaster University, St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada d Department of Surgery, Division of Plastic Surgery, University of Ottawa, 401-1919 Riverside Drive, Ottawa, ON K1H 1A2, Canada * Corresponding author. 206 James Street South, Suite 101, Hamilton, ON L8P 3A9, Canada E-mail address: athoma@mcmaster.ca (A. Thoma). - Preconditions for cost-effectiveness analysis Identification of all relevant treatment options Perspective taken The costs and consequences of the competing interventions - Cost-effectiveness - Types of economic evaluations - Discounting costs - Methodologic considerations - Sensitivity analysis - Controversy using incremental cost-utility ratios - Use of economic evaluations in clinical practice - Summary - References 285 0094-1298/08/$ – see front matter ª 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.cps.2007.10.012 plasticsurgery.theclinics.com