Health State Preference (Utility) in Facial Transplantation: Population-based Survey
Hani Sinno, MD, Stephanie Thibaudeau, Anil Duggal, MD, M.Sc., Marie-Lucie Lessard, MD,FRCSC,FRCSC,FACS.
McGill University, MUHC, Montreal, QC, Canada.
Facial transplantation has been performed in very few institutions for the management of facial disfigurement. Controversy exits as to whether the benefits of facial transplantation outweigh the risk of continuous immunosuppression. Utility score have been standardized to objectify health states or disease that may have controversial treatment options.
The goal of this study was to obtain a population-based utility assessment of the health burden of facial disfiguration which may be managed with facial transplantation.
An internet based utility assessment study using visual analogue scale (VAS), time tradeoff (TTO) and standard gamble (STG), was created to obtain utilities for facial transplantation from the general population and medical students. Data was collected from June - October 2008.
a total of n=197 people participated in the study. Seven participants were disqualified because of rating monocular blindness with a lower utility score that binocular blindness. The average utility score for monocular blindness (MB) was 0.76±0.17, binocular blindness (BB) was 0.54±0.25, face transplantation (FT) 0.6±0.25, and own health 0.93±0.13. There was a statistical difference between BB and FT when compared to MB (p<0.001). When BB and FT were compared, there was no difference in utility score in the STG with a P=0.12. There seemed to be a difference in the TTO (p<0.05) and VAS (p<0.001) test when BB was compared to FT. In subgroup analysis: the medical students (n=93) seemed to have the same face transplant utility scores as compared to the general public (n=97).
face disfigurement can be significantly debilitating and has been shown to be equivalent to binocular blindness using the STG. We have shown that people if faced with facial disfigurement, would undergo a face transplant procedure with 32 % mortality and/or give up 12.2 years of their life.