Research Article| Volume 65, ISSUE 1, P17-21, January 2012

The cost utility of reduction mammaplasty at medium-term follow-up: A prospective study

Published:August 29, 2011DOI:



      The effects of reduction mammaplasty (RM) have been proved in several randomised trials. However, publications regarding cost utility are infrequent and lacking with regard to medium-term follow-up. Therefore, we decided to assess the cost utility of RM at 2–5 years’ follow-up, when later costs and possible re-operations have been incurred.


      A total of 73 patients had bilateral RM between January 2005 and March 2007 in the Hospital District of Helsinki and Uusimaa, Finland. Health-related quality of life was measured with the 15D. Preoperative data were collected with an interview at an appointment and follow-up data by means of a postal survey. Direct hospital costs were obtained from the Ecomed® clinical patient administration database (Datawell Ltd., Espoo, Finland).


      A total of 62 (85%) patients agreed to participate in the study and returned the follow-up questionnaire. The mean follow-up time was 4.0 years (SD 0.53, range 2.3–4.6 years). The mean improvement in the 15D score change was 0.083 (SD 0.081). The mean number of quality-adjusted life years (QALYs) gained was 3.052 (SD 3.167, range 2.561–17.553). The mean hospital costs of the intervention were €3601 (SD 1321), and the mean cost per QALY gained was €1180. Roughly 76% of the costs were due to the hospital stay during the operation. Eight percent of the costs were incurred more than 6 months after the hospital stay.


      The cost per QALY gained by RM is low, even when considering later costs caused by possible re-operations, and compares favourably with a number of other surgical procedures.


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        • Saariniemi K.M.
        • Keranen U.H.
        • Salminen-Peltola P.K.
        • Kuokkanen H.O.
        Reduction mammaplasty is effective treatment according to two quality of life instruments. A prospective randomised clinical trial.
        J Plast Reconstr Aesthet Surg. 2008; 61: 1472-1478
        • Saariniemi K.M.
        • Joukamaa M.
        • Raitasalo R.
        • Kuokkanen H.O.
        Breast reduction alleviates depression and anxiety and restores self-esteem: a prospective randomised clinical trial.
        Scand J Plast Reconstr Surg Hand Surg. 2009; 43: 320-324
        • Iwuagwu O.C.
        • Walker L.G.
        • Stanley P.W.
        • Hart N.B.
        • Platt A.J.
        • Drew P.J.
        Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.
        Br J Surg. 2006; 93: 291-294
        • Iwuagwu O.C.
        • Stanley P.W.
        • Platt A.J.
        • Drew P.J.
        • Walker L.G.
        Effects of bilateral breast reduction on anxiety and depression: results of a prospective randomised trial.
        Scand J Plast Reconstr Surg Hand Surg. 2006; 40: 19-23
        • Freire M.
        • Neto M.S.
        • Garcia E.B.
        • Quaresma M.R.
        • Ferreira L.M.
        Functional capacity and postural pain outcomes after reduction mammaplasty.
        Plast Reconstr Surg. 2007; 119 (discussion 57–8): 1149-1156
        • Neto M.S.
        • Demattê M.F.
        • Freire M.
        • Carcia É.B.
        • Quaresma M.
        • Ferreira L.M.
        Self-esteem and functional capacity outcomes following reduction mammaplasty.
        Aesthetic Surg J. 2008; 28: 417-420
        • Taylor A.J.
        • Tate D.
        • Brandberg Y.
        • Blomqvist L.
        Cost-effectiveness of reduction mammaplasty.
        Int J Technol Assess Health Care. 2004; 20: 269-273
        • Tykkä E.
        • Räsänen P.
        • Tukiainen E.
        • et al.
        Cost-utility of breast reduction surgery – A prospective study.
        J Plast Reconstr Aesthet Surg. 2010; 63: 87-92
        • Rawlins M.
        • Dillon A.
        What’s the evidence that NICE guidance has been implemented? More recent data on NICE implementation show different picture.
        BMJ. 2005; 330 (discussion 86): 1086
        • Rawlins M.D.
        • Culyer A.J.
        National Institute for Clinical Excellence and its value judgments.
        BMJ. 2004; 329: 224-227
        • Rawlins M.
        • Dillon A.
        NICE discrimination.
        J Med Ethics. 2005; 31 (discussion 85–8): 683-684
        • Appleby J.
        • Devlin N.
        • Parkin D.
        • Buxton M.
        • Chalkidou K.
        Searching for cost effectiveness thresholds in the NHS.
        Health Policy. 2009; 91: 239-245
        • Wilmot S.
        Evidence, ethics and inclusion: a broader base for NICE.
        Med Health Care Philos, 2010
        • Blomqvist L.
        • Brandberg Y.
        Three-year follow-up on clinical symptoms and health-related quality of life after reduction mammaplasty.
        Plast Reconstr Surg. 2004; 114: 49-54
        • Borkenhagen A.
        • Rohricht F.
        • Preiss S.
        • Schneider W.
        • Brahler E.
        Changes in body image and health-related quality of life following breast reduction surgery in German macromastia patients: a new tool for measuring body image changes.
        Ann Plast Surg. 2007; 58: 364-370
        • Saariniemi K.M.
        • Kuokkanen H.O.
        • Tukiainen E.J.
        The outcome of reduction mammaplasty remains stable at 2–5 years' follow-up: A prospective study.
        J Plast Reconstr Aesthet Surg. 2011; 64: 573-576
        • Sintonen H.
        The 15D instrument of health-related quality of life: properties and applications.
        Ann Med. 2001; 33: 328-336
        • Hawthorne G.
        • Richardson J.
        • Day N.A.
        A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments.
        Ann Med. 2001; 33: 358-370
        • Sintonen H.
        The 15-D measure of health-related quality of life: II Feasibility, reliability and validity of its valuation system.
        (Working Paper 42) National Centre for Health Program Evaluation. National Health and Medical Research Council.1995, MelbourneMarch 5, 2011 (Available from Accessibility verified)
        • Stavem K.
        Reliability, validity and responsiveness of two multiattribute utility measures in patients with chronic obstructive pulmonary disease.
        Qual Life Res. 1999; 8: 45-54
        • Moock J.
        • Kohlmann T.
        Comparing preference-based quality-of-life measures: results from rehabilitation patients with musculoskeletal, cardiovascular, or psychosomatic disorders.
        Qual Life Res. 2008; 17: 485-495
      1. Finnish Ministry of Social Affairs and Health. Recommendations for health economical analysis. Available at: Accessed February 2011.

        • van Elk N.
        • Steegers M.A.
        • van der Weij L.P.
        • Evers A.W.
        • Hartman E.H.
        • Wilder-Smith O.H.
        Chronic pain in women after breast augmentation: prevalence, predictive factors and quality of life.
        Eur J Pain. 2009; 13: 660-661
        • Sigurdson L.
        • Mykhalovskiy E.
        • Kirkland S.A.
        • Pallen A.
        Symptoms and related severity experienced by women with breast hypertrophy.
        Plast Reconstr Surg. 2007; 119: 481-486
        • Behmand R.A.
        • Tang D.H.
        • Smith Jr., D.J.
        Outcomes in breast reduction surgery.
        Ann Plast Surg. 2000; 45: 575-580
        • Thoma A.
        • Sprague S.
        • Veltri K.
        • Duku E.
        • Furlong W.
        A prospective study of patients undergoing breast reduction surgery: health-related quality of life and clinical outcomes.
        Plast Reconstr Surg. 2007; 120: 13-26
        • Eskelinen E.
        • Rasanen P.
        • Alback A.
        • et al.
        Effectiveness of superficial venous surgery in terms of quality-adjusted life years and costs.
        Scand J Surg. 2009; 98: 229-233
        • Räsänen P.
        • Krootila K.
        • Sintonen H.
        • et al.
        Cost-utility of routine cataract surgery.
        Health Qual Life Outcomes. 2006; 4: 74
        • Räsänen P.
        • Ohman J.
        • Sintonen H.
        • et al.
        Cost-utility analysis of routine neurosurgical spinal surgery.
        J Neurosurg Spine. 2006; 5: 204-209
        • Räsänen P.
        • Paavolainen P.
        • Sintonen H.
        • et al.
        Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs.
        Acta Orthop. 2007; 78: 108-115
        • Devlin N.
        • Parkin D.
        Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis.
        Health Econ. 2004; 13: 437-452
        • Saarni S.I.
        • Harkanen T.
        • Sintonen H.
        • et al.
        The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D.
        Qual Life Res. 2006; 15: 1403-1414