(0718) Reconstruction of Oral Defects With Split Thickness Skin Graft Versus Integra: A Cost-Utility Analysis

Introduction: Although autologous split-thickness skin grafts (STSG) remains the standard of care for reconstruction of superficial oral defects following oral cancer resection, in recent years, biosynthetic skin substitutes, such as Integra, have been developed and used to combat the limitations of STSG. This study aims to evaluate the cost effectiveness of STSG compared to Integra for the purpose of oral cavity reconstruction.

Methods: A cohort-style Markov decision-tree economic model with a 5-year time horizon was developed in TreeAge Pro to compare STSG and Integra for reconstruction of appropriate oral defects following cancer resection. Model utilities and transitional probabilities were obtained from available literature. Costs were obtained from a payer perspective using national Medicare reimbursements available online. The primary outcome measure was incremental cost per quality-adjusted life-year (QALY), expressed as an incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analysis was conducted using 10,000 Monte Carlo simulations.

Results: In base case analysis over a 5-year timeframe, STSG was strongly dominated by Integra, and one-way sensitivity analysis suggests that these results were sensitive to the costs and health utilities of either strategy. Probabilistic sensitivity analysis reported a 95% probability of Integra being a cost-effective strategy for a willingness-to-pay threshold of $50,000/QALY. Compared to STSG, Integra yielded an average incremental benefit of 0.20 QALYs with an average cost savings of $10,547, resulting in an ICER of -$52,735/QALY.

Conclusions: Compared to STSG, Integra is cost-effective for the reconstruction of superficial defects of the oral cavity following oral cancer resection, potentially owing to its lack of donor site morbidity. However, more studies are needed to determine which patients will benefit most from Integra.