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Characterization of Face Transplant Candidates Evaluated at Cleveland Clinic and Algorithm to Maximize Efficacy of Screening Process. Ann Plast Surg 2021; 85:561-567. [PMID: 32657854 DOI: 10.1097/sap.0000000000002466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION As a high-volume referral center for facial transplantation, we have learned significantly from the screening, evaluation, and enrollment process. This report analyzes our algorithm for the assessment of potential face transplant candidates referred to our institution. METHODS After institutional review board approval in 2004, a prospectively maintained database was created for patients who were referred face transplant. Records were reviewed for the nature of tissue defect, functional deficit, surgical and medical history, and expert recommendations.Our algorithm begins with a review of a patient's file with a focus on institutional review board criteria. After screening, a phone interview is conducted, and transplantation is discussed. Patients are presented to the team to analyze the medical, psychiatric, and surgical history; support network; and geographic location. Eligible patients are invited for an in-person evaluation, and the case is reviewed again with the team. If approved, the patient can provide consent for transplantation. RESULTS More than 200 patients were referred for transplant evaluation at the Cleveland Clinic from 2004 to 2016. Sixty were eligible for further evaluation for face transplantation based on preliminary screening. Thirteen (6.5% of original cohort) were invited for in-person evaluation and physical examination. Five (2.5% of original cohort, 38.4% invited cohort) of these 13 patients underwent face transplantation, of whom, 3 (1.5% of original cohort, 23.1% invited cohort) underwent face transplantation at our institution. All 3 patients who were ultimately transplanted were referred by a physician. DISCUSSION As the availability of public information on face transplant increases, it is likely that an increase in self-referral for face transplantation will occur. Thus, it is critical that institutions adopt a systematic approach to triage in order to identify appropriate patients. Our algorithm allowed for a high enrollment and transplantation ratio to save patient and institution time and resources. This could be easily adopted by other institutions to save time, money, and resources.
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Facial Transplantation in a Nationalized Health System: The Canadian Experience. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3357. [PMID: 33564587 PMCID: PMC7858577 DOI: 10.1097/gox.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022]
Abstract
Facial transplantation (FT) is recognized as the ultimate reconstruction for severely disfigured patients. The substantial cost of these procedures in a nationalized health system has not been extensively published. The first Canadian FT performed in May 2018 was a great opportunity to address this subject and evaluate the viability of such a program.
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Benghiac AG, Garrett JR, Carter BS. Ethical issues in pediatric face transplantation. Pediatr Transplant 2017; 21. [PMID: 28845920 DOI: 10.1111/petr.13032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 11/30/2022]
Abstract
Facial transplantation has become a reality in adult medicine. Children are subject to congenital craniofacial differences, disease-related, traumatic, or thermochemical craniofacial changes and might be suitable for face transplantation. This manuscript addresses unique ethical issues in considering potential pediatric face transplant. These challenges are operant at the individual, technologic, and psychosocial level for clinicians, investigators, and society.
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Affiliation(s)
| | - Jeremy R Garrett
- Bioethics Center, Children's Mercy Hospital, Kansas City, MO, USA
| | - Brian S Carter
- Bioethics Center, Children's Mercy Hospital, Kansas City, MO, USA
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Chuback J, Yarascavitch B, Yarascavitch A, Kaur MN, Martin S, Thoma A. Measuring utilities of severe facial disfigurement and composite tissue allotransplantation of the face in patients with severe face and neck burns from the perspectives of the general public, medical experts and patients. Burns 2015; 41:1524-31. [DOI: 10.1016/j.burns.2015.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 12/22/2022]
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Alolabi N, Chuback J, Grad S, Thoma A. The utility of hand transplantation in hand amputee patients. J Hand Surg Am 2015; 40:8-14. [PMID: 25534832 DOI: 10.1016/j.jhsa.2014.08.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/22/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure the desirable health outcome, termed utility, and the expected quality-adjusted life years (QALYs) gained with hand composite tissue allotransplantation (CTA) using hand amputee patients and the general public. METHODS Using the standard gamble (SG) and time trade-off (TTO) techniques, utilities were obtained from 30 general public participants and 12 amputee patients. The health utility and net QALYs gained or lost with transplantation were computed. A sensitivity analysis was conducted to account for the effects of lifelong immunosuppression on the life expectancy of transplant recipients. Higher scores represent greater utility. RESULTS Hand amputation mean health utility as measured by the SG and TTO methods, respectively, was 0.72 and 0.80 for the general public and 0.69 and 0.70 for hand amputees. In comparison, hand CTA mean health utility was 0.74 and 0.82 for the general public and 0.83 and 0.86 for amputees. Hand CTA imparted an expected gain of 0.9 QALYs (SG and TTO) in the general public and 7.0 (TTO) and 7.8 (SG) QALYs in hand amputees. A loss of at least 1.7 QALYs was demonstrated when decreasing the life expectancy in the sensitivity analysis in the hand amputee group. CONCLUSIONS Hand amputee patients did not show a preference toward hand CTA with its inherent risks. With this procedure being increasingly adopted worldwide, the benefits must be carefully weighed against the risks of lifelong immunosuppressive therapy. This study does not show clear benefit to advocate hand CTA.
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Affiliation(s)
- Noor Alolabi
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Chuback
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sharon Grad
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Achilles Thoma
- Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Abstract
Vascularized composite allotransplantation is a continuously evolving area of modern transplant medicine. Recently, vascularized composite allografts (VCAs) have been formally classified as 'organs'. In this review, key aspects of VCA procurement are discussed, with a special focus on interaction with the procurement of classical solid organs. In addition, options for a matching and allocation system that ensures VCA donor organs are allocated to the best-suited recipients are looked at. Finally, the different steps needed to promote VCA transplantation in society in general and in the medical community in particular are highlighted.
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Affiliation(s)
- Axel Rahmel
- Deutsche Stiftung Organtransplantation, Deutschherrnufer 52, Frankfurt am Main, 60594 Frankfurt, Germany
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Flynn J, Zlotnik RS, Hanson MD, Borschel GH, Zuker R. Article Commentary: Pediatric facial transplantation: Ethical considerations. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jennifer Flynn
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador
| | - Randi Shaul Zlotnik
- Department of Bioethics, The Hospital for Sick Children
- Department of Paediatrics; University of Toronto, Toronto, Ontario
| | - Mark D Hanson
- Department of Psychiatry, Faculty of Medicine, University of Toronto
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ronald Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children
- Department of Surgery, University of Toronto, Toronto, Ontario
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Flynn J, Shaul RZ, Hanson MD, Borschel GH, Zuker R. Pediatric facial transplantation: Ethical considerations. Plast Surg (Oakv) 2014; 22:67-69. [PMID: 25114614 PMCID: PMC4116316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement.
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Affiliation(s)
- Jennifer Flynn
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador
| | - Randi Zlotnik Shaul
- Department of Bioethics, The Hospital for Sick Children, Faculty of Medicine, University of Toronto
- Department of Paediatrics, Faculty of Medicine, University of Toronto
| | - Mark D Hanson
- Department of Psychiatry, Faculty of Medicine, University of Toronto
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ronald Zuker
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
- Department of Surgery, University of Toronto, Toronto, Ontario
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Sinno HH, Ibrahim AMS, Izadpanah A, Thibaudeau S, Christodoulou G, Tahiri Y, Slavin SA, Lin SJ. Utility Outcome Assessment of the Aging Neck following Massive Weight Loss. Otolaryngol Head Neck Surg 2012; 147:26-32. [DOI: 10.1177/0194599812439028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The authors set out to quantify the health state utility assessment of living with the physical appearance of the aging neck following massive weight loss. Described utility scores may help to establish the health burden of the aging neck in the growing bariatric patient population. Study Design Prospective cohort observational study. Setting Tertiary referral medical center. Subjects and Methods Three validated tools were used to determine utility scores for living with an aging neck: visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG). A 5-point Likert scale was used to evaluate the subjects’ ease of understanding. A prospective sample of volunteers from the general population and medical students was used for this assessment. Results In total, 118 prospective volunteers were included in the survey. All measures (VAS, TTO, SG); (0.89 ± 0.07, 0.94 ± 0.08, and 0.95 ± 0.10, respectively) varied ( P < .0001) from the corresponding ones for monocular blindness (0.62 ± 0.18, 0.87 ± 0.15, and 0.85 ± 0.20, respectively) and binocular blindness (0.32 ± 0.18, 0.66 ± 0.25, and 0.64 ± 0.28, respectively). Conclusion The authors objectified the health state of living with an aging neck in the massive weight loss patient with utility scores (TTO, 0.94) comparable with those living with obstructive sleep apnea. This sample population, if faced with an aging neck following massive weight loss, would undertake a neck rejuvenation procedure with a theoretical 5% chance of mortality and would be willing to trade 2.1 years of remaining life-years to attain this procedure.
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Affiliation(s)
- Hani H. Sinno
- Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Canada
| | - Ahmed M. S. Ibrahim
- Division of Otolaryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Izadpanah
- Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Canada
| | - Stephanie Thibaudeau
- Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Canada
| | - George Christodoulou
- Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Canada
| | - Youssef Tahiri
- Division of Plastic and Reconstructive Surgery, Montreal General Hospital, McGill University, Montreal, Canada
| | - Sumner A. Slavin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel J. Lin
- Division of Otolaryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Chung KC, Shauver MJ, Saddawi-Konefka D, Haase SC. A decision analysis of amputation versus reconstruction for severe open tibial fracture from the physician and patient perspectives. Ann Plast Surg 2011; 66:185-91. [PMID: 20842003 PMCID: PMC4382673 DOI: 10.1097/sap.0b013e3181cbfcce] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although reconstruction is often the primary choice of surgeons after 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 was 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 the physicians and the patients highlight the necessity of realistic discussion of outcomes, regardless of the management methods.
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Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI, USA.
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Chung KC, Oda T, Saddawi-Konefka D, Shauver MJ. An economic analysis of hand transplantation in the United States. Plast Reconstr Surg 2010; 125:589-598. [PMID: 19910847 PMCID: PMC4387885 DOI: 10.1097/prs.0b013e3181c82eb6] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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 was to assess the utility and estimate the costs of hand transplantation and the use of hand prostheses for forearm amputations. METHODS One hundred 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 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 versus 28.81 QALYs; p = 0.03). Double hand transplantation was favored over the use of prostheses (26.73 QALYs versus 25.20 QALYs; p = 0.01). The incremental cost-utility ratio of double transplantation when compared with prostheses was $381,961/QALY, exceeding the traditionally accepted cost-effectiveness threshold of $50,000/QALY. CONCLUSIONS 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 incremental cost-utility ratio for hand transplantation.
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Affiliation(s)
- Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
| | - Takashi Oda
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
| | - Daniel Saddawi-Konefka
- Transitional Year Program, Saint Joseph Mercy Hospital System of Ann Arbor; Ann Arbor, MI
| | - Melissa J. Shauver
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
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Chung KC, Saddawi-Konefka D, Haase SC, Kaul G. A cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures. Plast Reconstr Surg 2009; 124:1965-1973. [PMID: 19952652 PMCID: PMC2788746 DOI: 10.1097/prs.0b013e3181bcf156] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lower extremity trauma is common. Despite an abundance of literature on severe injuries that can be treated with salvage or amputation, the appropriate management of these injuries remains uncertain. In this situation, a cost-utility analysis is an important tool in providing an evidence-based practice approach to guide treatment decisions. METHODS Costs following amputation and salvage were derived from data presented in a study that emerged from the Lower Extremity Assessment Project. The authors extracted relevant data on projected lifetime costs and analyzed them to include discounting and sensitivity analysis by considering patient age. The utilities for the various health states (amputation or salvage, including possible complications) were measured previously using the standard gamble method and a decision tree simulation to determine quality-adjusted life-years. RESULTS Amputation is more expensive than salvage, independently of varied ongoing prosthesis needs, discount rate, and patient age at presentation. Moreover, amputation yields fewer quality-adjusted life-years than salvage. Salvage is deemed the dominant, cost-saving strategy. CONCLUSION Unless the injury is so severe that salvage is not a possibility, based on this economic model, surgeons should consider limb salvage, which will yield lower costs and higher utility when compared with amputation.
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Affiliation(s)
- Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | | | - Steven C. Haase
- Assistant Professor of Surgery, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Gautam Kaul
- John C. and Sally S. Morley Professor of Finance, The University of Michigan's Stephen M. Ross School of Business, Ann Arbor, MI
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Cavaliere CM, Chung KC. Total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis: a decision analysis from the hand surgeons' perspective. J Hand Surg Am 2008; 33:1744-55, 1755.e1-2. [PMID: 19084173 PMCID: PMC4410850 DOI: 10.1016/j.jhsa.2008.06.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 06/19/2008] [Accepted: 06/24/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE Treatment of severely destroyed rheumatoid wrists with total wrist arthroplasty or total wrist arthrodesis relies on patient and surgeon preferences rather than rigorous prospective outcomes data. The purpose of this study is to develop a decision analytic model of arthroplasty and arthrodesis in rheumatoid arthritis (RA) using utility values obtained from a random sample of hand surgeons. METHODS A utility survey using a time trade-off design was administered to 175 members of the American Society for Surgery of the Hand. Based on the results of the survey, the utility values that surgeons assign to health states associated with arthroplasty and arthrodesis and their complications were calculated. By combining utility values with complication rates in the published literature, we developed a decision tree to calculate the expected quality-adjusted life years (QALYs) for each procedure compared to living with a painful RA wrist. RESULTS Based on surgeon preferences, living for 30 years with a painful, poorly functioning RA wrist (utility = 0.54) is associated with 16.2 QALYs. Treatment with arthroplasty (utility = 0.85) is associated with 25.5 QALYs, a gain of 9.3 QALYs over nonsurgical management. Arthrodesis (utility = 0.82) is associated with 24.6 QALYs, a gain of 8.4 QALYs over nonsurgical management. Arthroplasty is associated with a small incremental increase in QALYs (0.9) compared to arthrodesis. CONCLUSIONS Based on utility scores, hand surgeons feel that living with a painful, poorly functioning RA wrist for 30 years is worth approximately half as many years with a painless, well-functioning wrist. The outcomes for arthroplasty and arthrodesis are valued more than nonsurgical management. On the basis of its higher expected gain in QALYs, arthroplasty should be the preferred treatment. The minimal increase in utility for arthroplasty over arthrodesis suggests however, that surgeons do not view arthroplasty as superior to arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and decision analysis IV.
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Affiliation(s)
- Christi M. Cavaliere
- Clinical Lecturer, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System and VA Ann Arbor Health System; Ann Arbor, MI. Robert Wood Johnson Clinical Scholar, University of Michigan; Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
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Thoma A, Strumas N, Rockwell G, McKnight L. The Use of Cost-effectiveness Analysis in Plastic Surgery Clinical Research. Clin Plast Surg 2008; 35:285-96. [DOI: 10.1016/j.cps.2007.10.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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