Cost Analysis of Conventional Face Reconstruction versus Face Transplantation for Large Tissue Defects

Nguyen, Louis L.; Naunheim, Matthew R.; Hevelone, Nathanael D.; Diaz-Siso, J. Rodrigo; Hogan, John P.; Bueno, Ericka M.; Caterson, Edward J.; Pomahac, Bohdan

doi:10.1097/prs.0000000000000799

Cited by 29 publications

(22 citation statements)

References 27 publications

(17 reference statements)

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“…18 Compared with conventional reconstructive strategies, facial allograft transplantation is indeed more costly, but if severity of cases is taken into account, the cost profiles may look similar. 45 Overall, the actual cost-to-benefit ratio of facial allograft transplantation is still a matter of debate and this is another area in which further research is needed.…”

Section: Challenges Facing the Futurementioning

confidence: 99%

“…Many groups, including the Boston team, have published analysis and estimates on this topic. 45,46 Other information have been made available through media. 18 Compared with conventional reconstructive strategies, facial allograft transplantation is indeed more costly, but if severity of cases is taken into account, the cost profiles may look similar.…”

Section: Challenges Facing the Futurementioning

confidence: 99%

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Reflections on a Decade of Face Transplantation

2017

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On November 27, 2005, Isabelle Dinoire underwent the world's first partial face transplant in Amiens (France) after a dog attack had left her face severely disfigured. The abrupt surgical leap found the medical community and society unprepared to deal with the scientific, ethical, and societal implications of a surgical procedure that was striving to transition from sci-fi novels to science. Today, 10 years and over 35 transplants later, public opinion has become accustomed to the concept of "face restoration" through transplantation. However, face transplantation is far from being a safe "routine" surgery and the science behind it is still mostly unknown. Patients and multidisciplinary teams of physicians confront daily medical challenges, life-threatening risks, and personal struggle that only in part come to light. Could (or should) this be the laborious, uncertain, and high-risk trajectory of disruptive medical innovation? Over the last decade, some medical discoveries and surgical advancements in the field have been closely accompanied by partial regulatory frameworks, intense ethical discussions, and meaningful changes in social beliefs across cultures and continents. Yet, a very long way is to come and the questions we still have today greatly outweigh the answers we can offer. Here, we take the chance of the 10-year anniversary of face transplantation to reflect on the path traveled and to look forward to the challenges lying ahead.

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Section: Challenges Facing the Futurementioning

confidence: 99%

Section: Challenges Facing the Futurementioning

confidence: 99%

Reflections on a Decade of Face Transplantation

2017

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“…However, once adjusted for case severity and the potential for needing further operations, the cost profiles were similar-except for costly immunosuppression protocols needed in the VCA cohort. 80 That being said, standardized and widespread use are expected to lower costs, ultimately making these procedures more affordable for the health care system. 80 For the reasons described, many researchers are working on ways to increase graft survival (primarily through immunotolerance) and improve functional outcomes (primarily through peripheral nerve regeneration).…”

Section: Vascularized Composite Allotransplantation: From Mythology Tmentioning

confidence: 99%

Applied Bioengineering in Tissue Reconstruction, Replacement, and Regeneration

Colazo

Evans

Farinas

et al. 2019

Tissue Engineering Part B: Reviews

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To this day, tissue reconstruction and replacement to address extensive tissue defects due to trauma, tumor resection, genetic and/or chronic diseases, or excessive debridement present a major clinical challenge. Traditional reconstructive techniques most commonly utilize autologous tissue. Undoubtedly, autologous composite tissue transfers or ''flaps,'' skin grafts, as well as the harvesting of bone and/or cartilage have substantially improved the health, functional, and aesthetic outcomes of millions of patients. Unfortunately, these procedures are not without their drawbacks. These include increased operative time, complexity, cost, limited availability of qualitative autologous tissue, wound healing complications, tissue flap failure, and substantial donor-site morbidity. Recently, collaborative research teams-consisting of surgeons, scientists, and engineers-have made substantial progress in their attempts to solve these problems. This article provides historical perspective, covers the major limitations of current standards of care, and reviews recent advances and future prospects in applied bioengineering in the context of tissue reconstruction, replacement, and regeneration.

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“…A one-year comparative cost analysis in Boston using hospital billing records for conventional reconstruction (2000 to 2010) and facial CTA (2009 to 2011) patients supported this primary analysis, demonstrating that the mean one-year cost of facial CTA ($337,360) is significantly higher than that of conventional reconstruction ($70,230). However, adjustments based on the severity of injury and area of tissue loss resulted in similar cost profiles [10]. Furthermore, following the major expense during the initial month of surgery, a drastic fall in expenses for both surgical options was observed: mean conventional reconstruction costs decreased from $58,032 (month 1) to $1690 (month 10) while that of facial CTA fell from $231,879 (month 1) to $1722 (month 10).…”

Section: Cost Analyses Of Facial Cta In the Usamentioning

confidence: 99%

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

et al. 2019

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Background Facial composite tissue allotransplantation (CTA) may be considered in cases of severe facial injury. To date, no reports have analysed the cost of potential facial CTA in the UK. The aims of this study were to establish (1) the cost implications without facial CTA, necessitating multiple reconstructive procedures in cases with severe facial deformities, and (2) if facial CTA would be cost-effective in the UK given recent European and North American published cost analyses. Methods Hospital episodes' data from two potential candidates for facial CTA were used to calculate cost of treatment. In these cases, severe facial trauma was managed by multiple disciplinary teams performing numerous conventional reconstructive procedures. One case served as an indicator of the cost of primary reconstruction during the immediate post-traumatic episode, from admission until first discharge. The other served as an indicator of the accumulative cost of care following primary reconstruction from first discharge to six years later. Costs incurred served as a guide for the cost of standard reconstruction in the UK. These were compared with the costs of similar reconstructive procedures performed in the USA. This was used with data reporting the cost of facial CTA in the USA and France to predict the cost of facial CTA in the UK. Results Analysis revealed a cost benefit for facial CTA in a UK context that would become apparent from the third year posttransplant onwards. Conclusion Facial CTA may therefore be a more cost-effective long-term reconstructive option for patients with severe facial defects. Level of evidence: Level V, risk/prognostic study. declare that they have no conflict of interest.Ethical approval For this retrospective evaluation of cost, ethical approval is not required. However, all procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Informed consent For this type of study, formal consent is not required.Eur J Plast Surg (2020) 43:219-224 223Open Access This article is distributed under the terms of the Creative Comm ons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Cost Analysis of Conventional Face Reconstruction versus Face Transplantation for Large Tissue Defects

Cited by 29 publications

References 27 publications

Reflections on a Decade of Face Transplantation

Reflections on a Decade of Face Transplantation

Applied Bioengineering in Tissue Reconstruction, Replacement, and Regeneration

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

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