Abstract
While the ethical and technical concerns regarding facial transplantation have been discussed throughout this book, there is a lack of information regarding its cost. Moreover, there is no information available in the literature on the financial implications of complete reconstructions in patients with severe craniomaxillofacial defects. We have had the unique opportunity to compare the cost of traditional reconstructive procedures and face transplantation in a single patient in our institution. In addition, we have also been able to compare the financial data of three other patients who underwent conventional reconstruction in other institutions: Mount Sinai Medical Center in New York and the University of Chicago. As the field of transplantation evolves, it will become increasingly important to disseminate this valuable information. Given the current economic climate in medicine, it will undoubtedly be a central issue to the face transplant debate. The following chapter illustrates these issues by comparing the cost of multistaged conventional reconstructive procedures in four patients with the cost of the first US face transplant.
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Abbreviations
- ATG:
-
Anti-thymocyte Immunoglobulin
- CMV:
-
Cytomegalovirus
- CPT:
-
Current Procedural Terminology
- CTA:
-
Composite Tissue Allotransplantation
- ESRD:
-
End-Stage Renal Disease
- G-CSF:
-
Granulocyte Colony Stimulating Factor
- MMF:
-
Mycophenolate Mofetil
- PCP:
-
Pneumocystis Carinii Jerovici
- PCV:
-
Pneumococcal vaccine
- PTSD:
-
Post-Traumatic Stress Disorder
References
Agich GJ, Siemionow M. Until they have faces: the ethics of facial allograft transplantation. J Med Ethics. 2005;31:707-709.
Clark PA. Face transplantation: Part II-an ethical perspective. Med Sci Monit. 2005;11:RA41-RA47.
Alam DS, Papay F, Djohan R, et al. The technical and anatomical aspects of the World’s first near-total human face and maxilla transplant. Arch Facial Plast Surg. 2009;11:369-377.
The International Registry on Hand Composite Tissue Transplantation http://www.handregistry.com/. Accessed 7/1/2010, Monza, Italy and Lyon, France, 2009.
Concannon MJ. Discussion: an economic analysis of hand transplantation in the United States. Plast Reconstr Surg. 2010;125:599-600.
Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203-209.
Siemionow MZ, Papay F, Djohan R, et al. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg. 2010;125:111-122.
Coffman KL, Gordon C, Siemionow M. Psychological outcomes with face transplantation: overview and case report. Curr Opin Organ Transplant. 2010;15:236-240.
Gordon CR, Siemionow M, Papay F, et al. The world’s experience with facial transplantation: what have we learned thus far? Ann Plast Surg. 2009;63:572-578.
The 2010 Statistical Abstract; Births, deaths, marriages, and divorces: Life expectancy Washington, D.C.: United States Census Bureau, 2010:Table 103.
Siemionow M, Klimczak A. Tolerance and future directions for composite tissue allograft transplants: part II. Plast Reconstr Surg. 2009;123:7e-17e.
Guo S, Han Y, Zhang X, et al. Human facial allotransplantation: a 2-year follow-up study. Lancet. 2008;372:631-638.
Davies L. First hand and face transplant patient dies. http://www.guardian.co.uk/world/2009/jun/15/hand-face-transplant-patient-dies. Accessed 7/1/2010. London, U.K. 2009.
Macgregor FC. Facial disfigurement: problems and management of social interaction and implications for mental health. Aesthet Plast Surg. 1990;14:249-257.
Maner JK, Kenrick DT, Becker DV, et al. Sexually selective cognition: beauty captures the mind of the beholder. J Pers Soc Psychol. 2003;85:1107-1120.
Stevenage SV, Spreadbury JH. Haven’t we met before? The effect of facial familiarity on repetition priming. Br J Psychol. 2006;97(Pt 1):79-94.
Stevenage SV, Lee EA, Donnelly N. The role of familiarity in a face classification task using thatcherized faces. Q J Exp Psychol A. 2005;58:1103-1118.
Rumsey N, Clarke A, White P, Wyn-Williams M, Garlick W. Altered body image: appearance-related concerns of people with visible disfigurement. J Adv Nurs. 2004;48:443-453.
Levine E, Degutis L, Pruzinsky T, Shin J, Persing JA. Quality of life and facial trauma: psychological and body image effects. Ann Plast Surg. 2005;54:502-510.
Robinson E, Rumsey N, Partridge J. An evaluation of the impact of social interaction skills training for facially disfigured people. Br J Plast Surg. 1996;49:281-289.
Soni CV, Barker JH, Pushpakumar SB, et al. Psychosocial considerations in facial transplantation. Burns. 2010;36:959-964.
Morris PJ, Bradley JA, Doyal L, et al. Facial transplantation: a working party report from the Royal College of Surgeons of England. Transplantation. 2004;77:330-338.
Dubernard JM, Lengele B, Morelon E, et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med. 2007;357:2451-2460.
Lantieri L, Meningaud JP, Grimbert P, et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet. 2008;372:639-645.
Swanson E, Boyd JB, Manktelow RT. The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients. Plast Reconstr Surg. 1990;85:258-266.
Bardsley AF, Soutar DS, Elliott D, Batchelor AG. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg. 1990;86:287-292. discussion 93-94.
Anthony JP, Rawnsley JD, Benhaim P, Ritter EF, Sadowsky SH, Singer MI. Donor leg morbidity and function after fibula free flap mandible reconstruction. Plast Reconstr Surg. 1995;96:146-152.
Zimmermann CE, Borner BI, Hasse A, Sieg P. Donor site morbidity after microvascular fibula transfer. Clin Oral Investig. 2001;5:214-219.
Goodacre TE, Walker CJ, Jawad AS, Jackson AM, Brough MD. Donor site morbidity following osteocutaneous free fibula transfer. Br J Plast Surg. 1990;43:410-412.
Boyd JB. Deep Circumflex Iliac Groin Flaps. New York: Churchill Livingstone; 1989.
Smith AA, Bowen CV, Rabczak T, Boyd JB. Donor site deficit of the osteocutaneous radial forearm flap. Ann Plast Surg. 1994;32:372-376.
Richardson D, Fisher SE, Vaughan ED, Brown JS. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg. 1997;99:109-115.
Soutar DS, McGregor IA. The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases. Plast Reconstr Surg. 1986;78:1-8.
Youdas JW, Wood MB, Cahalan TD, Chao EY. A quantitative analysis of donor site morbidity after vascularized fibula transfer. J Orthop Res. 1988;6:621-629.
Boyd JB, Rosen I, Rotstein L, et al. The iliac crest and the radial forearm flap in vascularized oromandibular reconstruction. Am J Surg. 1990;159:301-308.
Swartz WM, Banis JC, Newton ED, Ramasastry SS, Jones NF, Acland R. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg. 1986;77:530-545.
Gordon CR, Siemionow M, Zins J. Composite tissue allotransplantation: a proposed classification system based on relative complexity. Transplant Proc. 2009;41:481-484.
Prihodova L, Nagyova I, Rosenberger J, Roland R, van Dijk JP, Groothoff JW. Impact of personality and psychological distress on health-related quality of life in kidney transplant recipients. Transpl Int. 2010;23:484-492.
Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective quality-of-life monitoring of simultaneous pancreas and kidney transplant recipients using the 36-item short form health survey. Am J Kidney Dis. 2010;55:698-707.
Knoll GA. Is kidney transplantation for everyone? The example of the older dialysis patient. Clin J Am Soc Nephrol. 2009;4:2040-2044.
Buchanan P, Dzebisashvili N, Lentine KL, Axelrod DA, Schnitzler MA, Salvalaggio PR. Liver transplantation cost in the model for end-stage liver disease era: looking beyond the transplant admission. Liver Transplant. 2009;15:1270-1277.
Simmons RG, Abress L, Anderson CR. Quality of life after kidney transplantation. A prospective, randomized comparison of cyclosporine and conventional immunosuppressive therapy. Transplantation. 1988;45:415-421.
Helderman JH, Kang N, Legorreta AP, Chen JY. Healthcare costs in renal transplant recipients using branded versus generic cyclosporin. Appl Health Econ Health Policy. 2010;8:61-68.
Asgeirsdottir TL, Asmundsdottir G, Heimisdottir M, Jonsson E, Palsson R. Cost-effectiveness analysis of treatment for end-stage renal disease. Laeknabladid. 2009;95:747-753.
Kasiske BL, Cohen D, Lucey MR, Neylan JF. Payment for immunosuppression after organ transplantation. American Society of Transplantation. JAMA. 2000;283:2445-2450.
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Gatherwright, J.R., Papay, F., Djohan, R., Rose, E.H., Gottlieb, L.J., Siemionow, M.Z. (2011). Comparative Cost Analysis of Conventional Reconstructions and the First US Face Transplantation. In: Siemionow, M. (eds) The Know-How of Face Transplantation. Springer, London. https://doi.org/10.1007/978-0-85729-253-7_29
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