Harijee Ankita, Thankappan Krishnakumar, Sharma Mohit, NageswaraRao Nagesh Noothanapati, Patel Tejal, Bhaskaran Renjitha, Raj Manu, Sundaram Karimassery Ramaiyer, Iyer Subramania
From the Department of Plastic & Reconstructive Surgery.
Department of Head & Neck Surgery and Oncology.
Ann Plast Surg. 2021 Mar 1;86(3):345-350. doi: 10.1097/SAP.0000000000002544.
Hand transplantation and advances in the field of prostheses have opened new frontiers in the restoration of hand function among bilateral hand amputees (BHA). There is only scarce literature evaluating the health utility (HU) and quality adjusted life years (QALY) gained by bilateral hand composite tissue allotransplantation (CTA) or prosthesis over amputation. The study was focused on BHA restored with prosthesis or CTA.
The HU of three different health states (HS) namely, BHA, using prosthesis or with CTA and net QALYs gained by hand transplantation or prosthesis over amputation were computed by time trade-off (TTO) method among 236 study participants.
Among 236 study participants, medical professional (120), general public (89), BHA (23), and bilateral hand transplant recipients (4) were included. The mean HU by TTO method among the study participants (n = 232) as BHA, using prosthesis or CTA was 0.34 (±0.24), 0.50 (±0.26) and 0.69 (±0.26) respectively. Bilateral hand CTA imparted an expected gain of 12.57 (±11.43) mean QALYs over amputation among the study participants. The subgroup analysis displayed higher mean HU in hand CTA recipient HS along with maximum QALY gained by CTA over amputation.
Bilateral hand CTA HS stands above the other 2 HSs, namely BHA and prosthesis, in terms of the health utility. As demonstrated by QALY gain of 12.57, participants' valuation of health utility is notably higher for CTA with acceptance of lifelong immunosuppressant rather than for a state of uncompromised physical health with a bilateral hand amputation.
手部移植和假肢领域的进展为双侧截肢者（BHA）手部功能的恢复开辟了新的前沿领域。仅有少量文献评估了双侧手部复合组织异体移植（CTA）或假肢相对于截肢所带来的健康效用（HU）和质量调整生命年（QALY）。本研究聚焦于通过假肢或CTA恢复手部功能的BHA。
通过时间权衡（TTO）方法，在236名研究参与者中计算了三种不同健康状态（HS）的HU，即BHA、使用假肢或接受CTA，以及手部移植或假肢相对于截肢所获得的净QALY。
236名研究参与者包括医学专业人员（120名）、普通公众（89名）、BHA（23名）和双侧手部移植受者（4名）。研究参与者（n = 232）中，作为BHA、使用假肢或接受CTA时，通过TTO方法得出的平均HU分别为0.34（±0.24）、0.50（±0.26）和0.69（±0.26）。在研究参与者中，双侧手部CTA相对于截肢预期可带来12.57（±11.43）个平均QALY。亚组分析显示，手部CTA受者健康状态的平均HU更高，且CTA相对于截肢获得的QALY最多。
在健康效用方面，双侧手部CTA健康状态优于其他两种健康状态，即BHA和假肢。如12.57的QALY增益所示，参与者对接受终身免疫抑制剂的CTA的健康效用评估明显高于双侧手部截肢但身体健康未受影响的状态。
