As Doctors for America, we focus on health care reform, because we want to make our system better than it is now. Such a desire to innovate is common in health care systems across all parts of the world. Perhaps, as health care providers, we are motivated by our patients’ situations to look for new ways to improve outcomes and decrease costs. Innovations in medicine in other parts of the world can inform how we might tailor our own health care system to better foster innovation.
In ORs everywhere, surgical mesh is used to patch up weakly reinforced areas of the body, such as the abdominal wall following a hernia repair, or a reconstructed breast following a mastectomy. Radical mastectomy, or, removal of breast tissue, underlying muscle, and axillary lymphatic tissue, is indicated in women who have a high risk of breast cancer because of genetic predisposition or other factors. Breast reconstruction surgery can help restore a woman’s physical curvature and psychological femininity following a mastectomy. The best outcomes of breast reconstruction procedures come closest to achieving the symmetry, homogeneity, and suppleness of a normal breast.
The creation of surgical mesh was revolutionary in many types of procedures, notably breast reconstruction post-mastectomy. Mesh aids in healing and recovery, but usually at high price. Lifecell is a biotechnology company that was once surrounded in controversy for allegedly illegally harvesting cadaver tissue from non-consenting deceased individuals. Lifecell also makes AlloDerm, or, as I’ve heard it so colloquially called, “WonderDerm”, or “CheatoDerm”. AlloDerm is a dissolvable mesh (it gets incorporated into the body) and it is the best of its kind (it’s derived from human tissue cells, after all).
While it is difficult to find exact figures, there is agreement amongst patients and medical professionals about the high cost of reconstructive surgery and the mesh that makes it possible. Breastcancer.org has discussion forums that reflect individual patient experiences. Patients report a typical breast reconstruction operation costs anywhere from $30,000 to $50,000. One patient on the discussion forums was incredulous at her hospital bill for $31,000, the majority of which went to purchasing AlloDerm. Another user on those forums says AlloDerm currently goes for $2,000 a pop (4x4 inch square). An alternative would be the silk-based SeriScaffold mesh made by Serica Technologies, though it is similarly priced. That’s a lot of money for a small amount of reinforcement.
In Germany, insurance doesn’t cover such medical luxuries for operations like post-mastectomy breast reconstruction. Just recently, Dieterich et al put their money on innovation and created a much more affordable titanium-coated polypropylene mesh and tried it in 231 German mastectomy patients. Why titanium? They compared how animals did with plain ‘ole mesh vs. titanium coated mesh and titanium was found to be more bioavailable. In follow up studies, the titanium coated mesh showed acceptable complication rates and can be a safe and convenient option in implant-based breast reconstruction. The mesh is even effective aesthetically, as it was barely palpable in the breast at follow up visits. We might get even better results with that here in America, one surgeon pointed out, considering that these authors’ German patients are probably thinner than our American patients.
German titanium polypropylene mesh is a much more affordable alternative to AlloDerm since there is no human tissue involved. It has the potential to save costs for the health care industry and offers acceptable post-surgical outcomes for as many patients as possible. American health care reform should take note of this affordable innovation, because we have the same goals as our German counterparts or any other nation’s physicians looking out for the well being of their patients. As Americans continue to build and improve upon our health care policies, we must reevaluate our current practices, technologies, and standards of care. In order to offer the high quality health care that lives up to the resources we have at our disposal, it is important to not get too comfortable paying through the nose for the norm.