A Critical Appraisal of the Department of Health and Aged Care Prescribed List Review of Surgical Guides and Anatomical Models Using a Systematic Review of Economic Evaluations

Objectives:
Critically appraise the economic evidence relevant to the Australian Department of Health’s Post-Listing Review of surgical guides and biomodels.

Methods:
Systematic review of virtual surgical planning (VSP) in jaw reconstruction aligned with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, CINAHL, and PubMed databases were searched on February 7, 2025. Inclusion criteria were health economic evaluations of VSP in jaw reconstruction studies.

Results:
Two studies found VSP to be cost-effective. One found VSP was not; however, the economic model was predicated on outdated clinical assumptions. Heterogeneity was reflective of modeling differences, rather than inherent lack of value. No studies adequately captured functional benefits such as speech, swallowing, and mastication or the reduction in revision procedures required for dental rehabilitation. High patient heterogeneity and ethical constraints restrict implementation of high-quality comparative trials in the most complex cases, in which VSP is mandatory. We support a complexity-based reimbursement system and present a rationale for flexibility in the biomodel and surgical guide limits. Future health economic evaluations should utilize modeling techniques, such as Markov modeling to capture benefits beyond immediate postoperative outcomes and include relevant quality-of-life domains.

Conclusion:
The current economic evidence is limited and methodologically inconsistent but when appropriately modeled, supports the value of VSP. Government conclusions based on incomplete evaluations underestimate its benefits and risk misinforming reimbursement policy. This article is imperative to clinical practice in head and neck reconstruction, equipping surgeons with evidence to challenge flawed funding frameworks and ensure patients continue to receive gold-standard, function-preserving care.