Surgical reconstruction of the mandible and maxilla: A health technology assessment in the Australian context

Abstract

Surgical resection of the mandible and maxilla is a standard treatment for jaw pathology, including tumours, trauma, infection, and osteonecrosis. Jaw resection profoundly impacts health-related quality of life (HRQoL) through impairments in aesthetics, speech, swallowing, and mastication. Microvascular free flap reconstruction is the current gold-standard, with adjuncts including virtual surgical planning (VSP) and immediate dental rehabilitation increasingly utilised for their link to improved outcomes.

Jaw reconstruction is one of the most resource-intensive procedures in head and neck surgery, yet considerable gaps in the economic literature preclude evidence-based decision-making. This thesis addresses these gaps through five interrelated studies.

A scoping review (Study 1) identified 36 studies, finding personnel costs as the primary cost-driver, but only 8% conducted full economic evaluations. Study 2, a micro-costing study of 100 patients, established a mean direct admission cost of A$54,988, with ward staffing, disposables, prostheses/VSP, and operating room staffing as the largest contributors. Study 3, a cost-minimisation analysis of 64 patients, demonstrated that point-of-care VSP (POC-VSP) reduced costs by A$9,835 per case versus commercial VSP, with economies of scale favouring POC-VSP beyond seven cases annually. Study 4, a cost-reimbursement analysis of 61 privately insured patients, found that 93–100% of cases were loss-making when overhead costs were included, with mean deficits of A$26,066–A$49,540, regardless of reimbursement model. Study 5 mapped the FACE-Q Head and Neck Cancer instrument to the EQ-5D-5L using beta regression as the optimal framework, enabling derivation of QALYs from FACE-Q data for future cost-utility analyses.

Collectively, this thesis establishes foundational economic evidence to inform clinical decision-making, resource allocation, and health policy for jaw reconstruction.