OBJECTIVES: Breast reconstruction rates continue to increase, with implant-based reconstruction rising at a faster pace than autologous modalities. This systematic literature review assessed model-based economic evaluations of medical devices used in the treatment of breast cancer.

METHODS: Embase.com (Embase^® and MEDLINE^®) was systematically searched (from database inception until May 2023), using PRISMA guidelines, by pairing relevant keywords to identify English-language studies. Electronic searches were supplemented by bibliographic and hand searches.

RESULTS: Among the 3,323 citations, four studies comparing different medical devices met the inclusion criteria. Cost–utility analysis following a decision tree approach was used in one of the included studies, conducted in the US; the other three studies used cost-effectiveness analyses. The incremental cost–utility ratio (ICER) for AeroForm tissue expander versus saline tissue expander was USD -206,901.36 per QALY using a third-party payer perspective. In a study of port catheter vs peripherally inserted central catheter, the ICER for the relative risk was EUR 400.24 using a health insurance perspective. From a healthcare perspective for unilateral implant-based reconstruction, compared with saline direct-to-implant (DTI), the ICER for silicone DTI was USD -60,995.49USD/QALY; for saline tissue expander-to-implant (TEI), USD -31,892.02/QALY; and for silicone TEI, USD ‑24,948.32/QALY. In a study comparing saline with silicone, the ICER was USD -283.48 per year of perfect breast-related health.

CONCLUSIONS: Surgeons need to understand how to navigate value analysis and economically justify products and technologies they require to provide optimal care for their patients. Current evidence suggests that saline implant reconstruction dominated silicone implant reconstruction and that AeroForm can be strongly considered to supplant the use of saline tissue expanders following mastectomy. However, results should be interpreted with caution due to the paucity of data and heterogeneity in medical devices considered in the models. Further exploration of cost-effective options for medical devices is warranted in future.