Alolabi Noor, Chuback Jennifer, Grad Sharon, Thoma Achilles
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.
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.
J Hand Surg Am. 2015 Jan;40(1):8-14. doi: 10.1016/j.jhsa.2014.08.048.
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.
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.
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.
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.
使用手部截肢患者和普通公众来测量理想的健康结果，即效用，以及手部复合组织异体移植（CTA）所获得的预期质量调整生命年（QALY）。
采用标准博弈（SG）和时间权衡（TTO）技术，从30名普通公众参与者和12名截肢患者中获取效用值。计算移植所获得或损失的健康效用和净QALY。进行敏感性分析以考虑终身免疫抑制对移植受者预期寿命的影响。分数越高表示效用越大。
通过SG和TTO方法测量，普通公众手部截肢的平均健康效用分别为0.72和0.80，手部截肢患者为0.69和0.70。相比之下，普通公众手部CTA的平均健康效用为0.74和0.82，截肢患者为0.83和0.86。手部CTA使普通公众预期获得0.9个QALY（SG和TTO），手部截肢患者预期获得7.0（TTO）和7.8（SG）个QALY。在手部截肢患者组的敏感性分析中，当降低预期寿命时，显示至少损失1.7个QALY。
手部截肢患者对具有固有风险的手部CTA没有表现出偏好。随着该手术在全球范围内越来越多地被采用，必须仔细权衡其益处与终身免疫抑制治疗的风险。本研究未显示倡导手部CTA有明显益处。
