Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

BACKGROUND: We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. METHODS: Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. RESULTS: Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. CONCLUSIONS: The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries.

Massage by nurses in the United States and the People's Republic of China: a comparison.

Massage performed by a Chinese nurse is described as observed by the author. A brief history of both Eastern and Western massage is presented. A comparison of theory, indications, methods, and outcomes of massage as performed by nurses from the United States (U.S.) and the People's Republic of China is made. The comparison is based on nursing texts and journals printed in the U.S., the author's personal experience in the People's Republic of China, correspondence with a nurse from the People's Republic of China, and texts and journals printed in English in the People's Republic of China. Massage as a nursing intervention differed on many points of comparison between the two countries. Chinese nurses perform massage over the meridians which are the channels for Chi--the life force of energy. Nurses in the U.S. perform massage over tense muscles. Massage performed by U.S. nurses involves three to five strokes while Chinese nurses use dozens of strokes. In China, massage is considered curative; in the U.S. it is mostly palliative.