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We evaluated cost\u2010effectiveness of nine methods of immediate breast reconstruction for women with localized breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Markov modeling was performed over 10\u2010years for unilateral\/bilateral breast reconstructions from healthcare\/societal perspectives. PubMed, Embase, Cochrane, Scopus, and CINAHL were searched to derive data from 13,744 patients in 79 prospective studies. Complications requiring surgery (mastectomy necrosis, total\/partial flap necrosis, seroma, hematoma, infection, wound dehiscence, abdominal hernia, implant removal\/explantation) and revisions (fat necrosis, capsular contracture, asymmetry, scars\/redundant tissue, implant rupture\/removal, fat grafting) were evaluated over yearly cycles. Reconstructions included: direct\u2010to\u2010implant (DTI), tissue expander\u2010to\u2010implant (TEI), latissimus dorsi flap\u2010to\u2010implant (LDI), latissimus dorsi (LD), pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator\/superficial inferior epigastric artery (DIEP\/SIEA), thigh\u2010based, or gluteal based flaps. Outcomes were incremental cost\u2010effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness\u2010to\u2010pay thresholds were $50,000 and $100,000.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From a healthcare perspective for unilateral reconstruction, compared to LD, the ICER for DTI was \u2212$42,109.35\/quality\u2010adjusted life\u2010years (QALY), LDI was \u2212$25,300.83\/QALY, TEI was \u2212$22,036.02\/QALY, DIEP\/SIEA was $8307.65\/QALY, free TRAM was $8677.26\/QALY, pedicled TRAM was $13,021.44\/QALY, gluteal\u2010based was $17,698.99\/QALY, and thigh\u2010based was $23,447.82\/QALY. NMB of DIEP\/SIEA was $404,523.47, free TRAM was $403,821.40, gluteal\u2010based was $392,478.64, thigh\u2010based was $387,691.70, pedicled TRAM was $376,901.83, LD was $370,646.93, DTI was $339,668.77, LDI was $334,350.30, and TEI was $329,265.84.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>All nine methods of immediate breast reconstruction were considered cost\u2010effective from healthcare\/societal perspectives. LD provided the lowest costs, while DIEP\/SIEA provided the greatest effectiveness and NMB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.30882","type":"journal-article","created":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T03:40:37Z","timestamp":1648698037000},"page":"401-427","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Comparison of nine methods of immediate breast reconstruction after resection of localized breast cancer: A cost\u2010effectiveness Markov decision analysis of prospective studies"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2742-4319","authenticated-orcid":false,"given":"Kevin M.","family":"Klifto","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery University of Missouri School of Medicine  Columbia Missouri USA"},{"name":"Division of Plastic Surgery, Department of Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Tecce","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"Serletti","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Kovach","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery University of Pennsylvania Perelman School of Medicine  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"134","article-title":"Immediate breast reconstruction with expander assisted latissimus dorsi flap after skin sparing mastectomy","volume":"18","author":"Abdalla H. 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