SA1 - A Cost Analysis of Custom Endoprostheses for Pediatric Mandibular and Maxillary Reconstruction

Abstract: Statement of the Problem: Pediatric maxillary and mandibular reconstruction following tumor resection or other pathologic processes requires surgical hardware to restore structural stability, maintain facial symmetry, and enable oral function. Traditionally, reconstruction has utilized standard, manually contoured plates; however, advances in virtual surgical planning have led to increasing use of custom, patient-specific endoprostheses. These custom implants offer potential technical advantages, including improved anatomic fit and decreased intraoperative contouring. Despite these benefits, the financial implications of custom hardware in the pediatric population remain poorly defined. This study aims to evaluate cost differences, reimbursement patterns, and associated clinical factors between custom and non-custom reconstruction plates.

Methods: A retrospective cohort study was conducted at a single tertiary children's hospital, including pediatric patients who underwent maxillary and/or mandibular reconstruction between 2014 and 2025. Inclusion criteria included patients under 18 years of age who received either custom or standard (non-custom) reconstruction plates from a single manufacturer with complete invoice and reimbursement data. Data collected included demographics, insurance status, indication for reconstruction, type of reconstruction, hardware type, operative time, hardware cost, and reimbursement.

Method of Data Analysis: Statistical analysis included descriptive and inferential methods. Continuous variables were summarized using means and standard deviations, while categorical variables were reported as frequencies and percentages. The sample included 28 operations over an 11-year period. Univariate comparisons were performed, followed by multivariable linear regression to identify independent predictors of cost, operative time, and reimbursement. Statistical significance was defined as P < .05.

Results: A total of 28 pediatric reconstruction procedures met inclusion criteria. The cohort was predominantly male (57.1%), Hispanic (60.7%), and publicly insured (85.7%). Most reconstructions followed mass resection (96.4%), with mandibular cases comprising 78.6% and maxillary cases 21.4%.

Thirteen procedures (46.4%) utilized custom endoprostheses, while 15 (53.6%) utilized non-custom plates. Mean hardware cost was significantly higher in the custom group ($66,718 ± 13,667) compared to the non-custom group ($13,456 ± 19,743), a mean difference of $53,263 (P < .001). On multivariable analysis, non-custom plates were independently associated with a $27,946 reduction in hardware cost (P = .001).

Operative time was longer in custom cases on unadjusted analysis (P = .002), but this difference was not significant after adjustment (P = .865). Non-custom plates were associated with a 15.1% higher reimbursement rate (P = .017), while public insurance predicted a 21.9% lower reimbursement rate (P = .004).

Conclusions: Custom endoprostheses for pediatric jaw reconstruction are associated with substantially higher costs and lower reimbursement compared to standard plates. While they may offer technical advantages, these benefits must be weighed against financial impact. The lack of adjusted operative time differences further highlights the need to assess cost-effectiveness. Future studies evaluating long-term clinical outcomes are needed to better define the role of custom hardware in pediatric reconstruction.


References:

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2. Chang PB, Robie BH, Bartel DL. Preclinical cost analysis of orthopaedic implants: a custom versus standard cementless femoral component for revision total hip arthroplasty. J Biomech. 1999;32(12):1309-18. doi: 10.1016/s0021-9290(99)00097-4