In the absence of clinical data, the decision to proceed with facial allotransplantation is dependent on measurable outcomes or expected utility of transplantation. In health economics, the term “utility” refers to preference for or desirability of a particuclar outcome. Utility scales are defined such that dead and perfect health are assigned values of 0 and 1, respectively. For instance, the utility of moderate angina has been reported as 0.90 and a kidney transplant as 0.84. The purpose of this study was to ascertain the utility values associated with severe facial disfigurement, as a prelude to facial composite tissue allogransplantation.
In this investigation, the utilities of facial disfigurement were obtained from a sample of convenience (n = 60) that included various health care professionals. Utilities (or preferences for the stated health outcome) were computed from values obtained with the “feeling thermometer” (FT), standard gamble (SG), and time trade off (TTO) measures. The FT is a vertical ladder ascending from a score of 0 (representing death) to 1 (representing perfect health). The SG presents participants with choices A and B, the former consisting of varying probabilities of successful facial transplantation and associated complications, and the latter representing severe facial disfigurement. With the TTO, participants are asked to consider how many years of successful facial allotransplantation are equivalent to facial disfigurement for the remainder of one's life. For the latter two measures, successful facial transplantation was defined as allotransplantation without the occurrence of the associated complications of surgery and requisite immunosuppressive therapy.
Utilities for facial disfigurement were 0.23 ± 0.17, 0.33 ± 0.25, and 0.36 ± 0.23 as computed with the FT, SG, and TTO measures, respectively. The low preferences for the above mentioned health state suggest that the desirability of severe facial disfigurement is such that participants were apt to accept a greater chance of immunosuppression-associated complications of allotransplantation, or alternatively stated, were willing to forego a significant portion of life in order to avoid it.
The current debate within the medical community surrounding facial allotransplantation has centered on the issue of the inherent risk associated with life-long immunosuppression for a non-essential procedure, performed primarily to confer a better quality of life. The results from this study indicate that severe facial deformity is deemed so unfavorable that the population surveyed would prefer facial transplantation and the side effects of immunosuppression rather than remain in that health state.
