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Plain-language core. Switch lenses to reveal technical or purchasing detail.
All topics
  1. What it is
  2. Why it matters
  3. Timing
  4. The procedure
  5. Patient journey
  6. Recovery supplies
  7. Implant materials
  8. Side-by-side
  9. US manufacturers
  10. What the evidence says
  11. Value analysis
  12. Questions to ask
  13. Glossary
  14. Resources
  15. References

For hospitals

Value analysis considerations

Implant price is only one part of the cost of cranioplasty. Repeat surgery, longer hospital stays and bone banking all add cost, and so does the clinical toll on the patient.

Evidence relevant to value
  • Reoperation avoidance. Revision rates ranged from 5% (PEEK) to 19% (autograft) in one network meta-analysis.6 Each revision is a second procedure with its own OR, implant, and inpatient costs.
  • Length of stay. Titanium was associated with a 3.62-day shorter stay than autologous bone.11
  • High-risk subgroups. Pediatric patients, TBI patients, and flaps stored more than a year carry higher resorption risk with autologous bone.8,10 TBI did not raise reoperation risk with alloplastic implants.10
  • Cost comparisons are limited. One meta-analysis found titanium and autologous costs comparable.21 Very low-cost in-house patient-specific methods have been described outside the US regulatory setting.22,23
Questions for a value analysis committee
  • What is our case mix by indication (TBI, stroke, tumor, infection) and by patient age?
  • What are our current revision, infection and resorption rates, and what does a revision cost us?
  • Do we bank bone flaps, and what does storage and handling cost per case?
  • Which defects need patient-specific design, and what manufacturing lead time can our scheduling absorb?
  • Is each product FDA cleared for cranial reconstruction, and what is its regulatory pathway?
  • Which materials do our surgeons have experience with, and for which patients would each be preferred?

Switch the reading lens above to Value analysis to see hospital purchasing considerations.

Sources for this page

  1. Henry J, et al. Complications of cranioplasty in relation to material: systematic review, network meta-analysis and meta-regression. Neurosurgery. 2021;89(3):383-394. doi:10.1093/neuros/nyab180
  2. Fan MC, et al. Cryopreservation of autologous cranial bone flaps for cranioplasty: a large sample retrospective study. World Neurosurg. 2018;109:e853-e859. doi:10.1016/j.wneu.2017.10.112
  3. Henry J, et al. Complications of cranioplasty following decompressive craniectomy for traumatic brain injury: systematic review and meta-analysis. Acta Neurochir. 2021;163(5):1423-1435. doi:10.1007/s00701-021-04809-z
  4. Khalid SI, et al. Materials used in cranial reconstruction: a systematic review and meta-analysis. World Neurosurg. 2022;164:e945-e963. doi:10.1016/j.wneu.2022.05.073
  5. Capitelli-McMahon H, et al. Titanium versus autologous bone-based cranioplasty: a systematic review and meta-analysis. Cureus. 2023;15(5):e39516. doi:10.7759/cureus.39516
  6. Ashraf M, et al. Early experience with patient-specific low-cost 3D-printed PMMA cranioplasty implants in a lower-middle-income country. Surg Neurol Int. 2022;13:270. doi:10.25259/SNI_250_2022
  7. Dash C, et al. A novel prefabricated patient-specific titanium cranioplasty: reconsideration from a traditional approach. Oral Maxillofac Surg. 2022;26(2):223-228. doi:10.1007/s10006-021-00977-5

All references