Utility scores for facial disfigurement requiring facial transplantation [outcomes article].
BACKGROUND
Controversy exists as to whether the benefits of facial transplantation outweigh the risk of continuous immunosuppression. Utility scores [range, 0 (death) to 1 (perfect health)] are a standardized tool with which to objectify health states or diseases and can help answer such controversy.


METHODS
An Internet-based utility assessment study using visual analogue scale, time trade-off, and standard gamble was used to obtain utilities for facial disfigurement requiring facial transplantation from a sample of the general population and medical students at McGill University. Average utility scores were compared using t test, and linear regression was performed using age, race, and education as independent predictors of each of the utility scores.


RESULTS
A total of 307 people participated in the study. All measures (visual analogue scale, time trade off, and standard gamble) for facial disfigurement (0.46 + or - 0.02, 0.68 + or - 0.03, and 0.66 + or - 0.03, respectively) were significantly different (p < 0.001) from the corresponding ones for monocular blindness (0.62 + or - 0.02, 0.83 + or - 0.02, and 0.82 + or - 0.02, respectively) and binocular blindness (0.33 + or - 0.02, 0.62 + or - 0.03, and 0.61 + or - 0.03, respectively). Age was inversely proportional to the utility scores in all groups (p < 0.01), decreasing a utility score of 0.006 for every increase in year of age.


CONCLUSIONS
A sample of the general population and medical students, if faced with facial disfigurement, would undergo a face transplant procedure with a 34 percent chance of death and be willing to trade 12 years of their life to attain perfect health.
Sinno
Hani H
HH
Montreal, Quebec, Canada From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University.
Thibaudeau
Stephanie
S
Duggal
Anil
A
Lessard
Lucie
L
D000367:Age Factors; D001828:Body Image; D015331:Cohort Studies; D019465:Craniofacial Abnormalities / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D005151:Facial Injuries / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D054445:Facial Transplantation / Q000379:methods*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D015601:Injury Severity Score; D020407:Internet; D016014:Linear Models; D008297:Male; D010147:Pain Measurement; D057240:Patient Preference; D011336:Probability; D011788:Quality of Life; D011792:Quebec; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D012938:Social Perception; D011795:Surveys and Questionnaires; D055815:Young Adult