Composite tissue allotransplantation of the face: Decision analysis model

Cugno, Sabrina; Sprague, Sheila; Duku, Eric; Thoma, Achilleas

doi:10.1177/229255030701500304

Cited by 18 publications

(16 citation statements)

References 55 publications

(36 reference statements)

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“…The probabilities of complication have also been based on short-term results because these data are strictly derived from randomized controlled trials. (28) Long-term result would demonstrate higher rates of death and major complication such as malignancies and serious infections. Finally, hypertension and diabetes mellitus represented minor and major complications, respectively.…”

Section: Discussionmentioning

confidence: 99%

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An Economic Analysis of Hand Transplantation in the United States

Chung

Oda

Saddawi-Konefka

et al. 2010

Plastic and Reconstructive Surgery

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Background Hand transplantation has received international attention in recent years; however, the economic impact of this innovative treatment is uncertain. The aim of this study is to assess the utility and estimate the costs of hand transplantation and the use of hand prostheses for forearm amputations. Methods 100 medical students completed a time trade-off survey to assess the utilities of single and double hand transplantation and the use of hand prostheses. Quality-adjusted life years (QALYs) were calculated for each outcome to create decision trees. Cost data for medical care were estimated based on Medicare fee schedules using the Current Procedural Terminology code for forearm replantation. The cost of immunosuppressive therapy was estimated based on the wholesale price of drugs. The incremental cost-utility ratio (ICUR) was calculated from the differences in costs and utilities between transplantation and prosthesis. Sensitivity analyses were performed to assess the robustness of the results. Results For unilateral hand amputation, prosthetic use was favored over hand transplantation (30.00 QALYS vs. 28.81 QALYs; p = 0.03). Double hand transplantation was favored over the use of prostheses (26.73 QALYs vs. 25.20 QALYs; p = 0.01). The ICUR of double transplantation when compared with prostheses was $381,961/QALY, exceeding the traditionally accepted cost-effectiveness threshold of $50,000/QALY. Conclusion Prosthetic adaption is the dominant strategy for unilateral hand amputation. For bilateral hand amputation, double hand transplantation exceeds the societally acceptable threshold for general adoption. Improvements in immunosuppressive strategies may change the ICUR for hand transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

An Economic Analysis of Hand Transplantation in the United States

Chung

Oda

Saddawi-Konefka

et al. 2010

Plastic and Reconstructive Surgery

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“…17 We used the standard method for calculating QALYs, which considers time spent recovering from complications and the utility of those compilicaitons. 18,19 (Figure 3) Complication times were calculated as a percentage of a year. For example, flap failure requires approximately 3 weeks of additional treatment.…”

Section: Methodsmentioning

confidence: 99%

A Decision Analysis of Amputation Versus Reconstruction for Severe Open Tibial Fracture from the Physician and Patient Perspectives

Chung¹,

Shauver²,

Saddawi-Konefka³

et al. 2011

Annals of Plastic Surgery

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Although reconstruction is often the primary choice of surgeons following an open tibial fracture, there is no evidence to support the long-term effectiveness of flap reconstruction over below-knee amputation. The aim of this study is to perform a decision analysis to evaluate treatment preferences for type IIIB and IIIC tibial fractures. Reconstructive microsurgeons, physical medicine physicians and patients with lower extremity trauma completed a web-based standard gamble utility survey to generate quality-adjusted life years (QALYs). Physicians assigned quite high utility values, and there was a slight preference for reconstruction over amputation, with a gain of only 0.55 QALY. Patients assigned significantly lower utility values and also favored reconstruction over amputation, but with a larger gain of 5.54 QALYs. The disparate utilities assigned by physicians and patients highlight the necessity of realistic discussion of outcomes, regardless of management methods.

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“…(14) Therefore, we assume that the risks of immunosuppression associated with hand transplantation would be similar to the risks associated with immunosuppression following kidney transplantation. (14,18,28) We categorized complications of hand transplantation into four states: death, major complications, minor complications and graft loss due to rejection. Major complications included potentially life-threatening conditions and diseases requiring inpatient care such as opportunistic infection, diabetes mellitus, post-transplant lymphoproliferative diseases, leukopenia, and acute rejection.…”

Section: Methodsmentioning

confidence: 99%