A European perspective of the cost effectiveness of facial composite tissue allotransplantation

Facial composite tissue allotransplantation is an emerging field which offers the potentially restore facial form and function, even following the most severe traumatic injuries. This benefit must be carefully weighed against the need to lifelong immunosuppression, associated infection risks, and possible rejection. Patients must be carefully screened for medical and psychiatric issues prior to the procedure. However, in the well-selected patient, this procedure can be transformative. Uniformly, patients self-report a dramatic improvement post transplantation. In addition, return of sensation in the transplanted allograft occurs in 3–6 months, although return of motor function takes longer and remains incomplete. Ultimately, facial composite tissue transplantation is a powerful technique in the properly selected patient.

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Composite tissue allotransplantation of the face: Decision analysis model

Canadian Journal of Plastic Surgery ◽

10.1177/229255030701500304 ◽

2007 ◽

Vol 15 (3) ◽

pp. 145-152 ◽

Cited By ~ 9

Author(s):

Sabrina Cugno ◽

Sheila Sprague ◽

Eric Duku ◽

Achilleas Thoma

Keyword(s):

Decision Analysis ◽

Current Debate ◽

Decision Analysis Model ◽

Composite Tissue Allotransplantation ◽

Face Transplantation ◽

Facial Disfigurement ◽

Composite Tissue ◽

Life Years ◽

The Face ◽

Facial Composite

Background Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure. Study Design The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed. Results Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years. Conclusions The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.

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