Abstract
BACKGROUND: Rising abdominoplasty costs in the United States have driven patients to seek affordable options abroad despite risks, fueling the medical tourism industry. This study compared the cost-effectiveness of abdominoplasty performed in the United States versus abroad. METHODS: Patients presenting to an academic hospital's emergency department with complications from out-of-state/country abdominoplasties (2018-2022) were surveyed. Utility scores were obtained from the survey and used to calculate quality-adjusted life years (QALYs) for each health state. Probabilities and outcomes were obtained by literature review, and a decision-analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost-utility ratio was calculated with a willingness-to-pay threshold of $100,000 per QALY. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Cosmetic tourism abdominoplasty was associated with a lower clinical effectiveness (QALY 39.08) compared with abdominoplasty in the United States (39.09), and a relative cost decrease of $2066.26. The incremental cost-utility ratio of $811,471.83 per QALY did not result in cosmetic tourism abdominoplasty being cost-effective. Although the lower costs of cosmetic tourism are appealing, the marginal difference in clinical effectiveness raises concerns about the overall value. In the case that the cost of the cosmetic tourism abdominoplasty was less than $7061.63, 1-way sensitivity analyses showed that this option was more cost-effective than abdominoplasty in the United States, with 68.03% Monte Carlo confidence. CONCLUSIONS: Cosmetic tourism abdominoplasty may be cost-effective only when priced less than $7061.63. This analysis may inform patients' reservation prices, considering postoperative complications, follow-up, and long-term relationships with healthcare providers.