Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, and Transitional Year Program, Saint Joseph Mercy Hospital System of Ann Arbor.
Plast Reconstr Surg. 2010 Feb;125(2):589-598. doi: 10.1097/PRS.0b013e3181c82eb6.
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.
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.
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.
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.
近年来，异体手移植受到国际关注；然而，这种创新治疗的经济影响尚不确定。本研究旨在评估异体手移植和假肢用于前臂截肢的效用，并估算其成本。
100 名医学生完成了时间权衡调查，以评估单手和双手移植以及假肢使用的效用。为每个结果计算了质量调整生命年（QALY），以创建决策树。根据医疗保险费用表，使用前臂再植的当前程序术语（CPT）代码估算医疗保健的成本数据。根据药物的批发价格估算免疫抑制治疗的成本。从移植和假肢之间的成本和效用差异计算增量成本效用比。进行敏感性分析以评估结果的稳健性。
对于单侧手截肢，假肢的使用优于手移植（30.00 QALY 与 28.81 QALY；p = 0.03）。双手移植优于假肢使用（26.73 QALY 与 25.20 QALY；p = 0.01）。与假肢相比，双手移植的增量成本效用比为 381,961 美元/QALY，超过了传统上 50,000 美元/QALY 的成本效益阈值。
假肢适应是单侧手截肢的主导策略。对于双侧手截肢，双手移植超过了普遍接受的社会可接受阈值。免疫抑制策略的改进可能会改变手移植的增量成本效用比。
