title: Cost analysis of conventional facial reconstruction procedures followed by face transplantation.
abstract: For the first time, this study analyzes the cost of multiple conventional reconstructions and face transplantation in a single patient. This patient is a 46-year-old female victim of a shotgun blast resulting in loss of multiple functional and aesthetic subunits. For over 5 years, she underwent multiple conventional reconstructions with suboptimal results. In December 2008, she became the recipient of the first U.S. face transplant. This has provided the unique opportunity to present the cost of 23 separate conventional reconstructive procedures and the first face transplant in the United States. The combined cost of conventional reconstructive procedures and the first U.S. face transplant was calculated to be $353 480 and $349 959, respectively. The combined cost posttransplant totaled $115 463. The direct cost pretransplant was $206 646, $232 893 peritransplant and $74 236 posttransplant. The two largest areas of cost utilization were surgical ($79 625; 38.5%) and nursing ($55 860; 27%), followed by anesthesia ($24 808; 12%) and pharmacy ($16 581; 8%). This study demonstrates that the cost of the first U.S. face transplant is similar to multiple conventional reconstructions. Although the cost of facial transplantation is considerable, the alleviation of psychological and physiological suffering, exceptional functional recovery and fulfillment of long-lasting hope for social reintegration may be priceless.
authors.affiliation: Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH Department of Plastic Surgery, University Hospitals, Cleveland, OH, USA. siemiom@ccf.org
authors.forename: M
authors.initials: M
authors.lastname: Siemionow
authors.forename: J
authors.initials: J
authors.lastname: Gatherwright
authors.forename: R
authors.initials: R
authors.lastname: Djohan
authors.forename: F
authors.initials: F
authors.lastname: Papay
mesh_terms: D003365:Costs and Cost Analysis; D003586:Cytomegalovirus Infections / Q000191:economics / Q000209:etiology; D005151:Facial Injuries / Q000191:economics* / Q000601:surgery*; D054445:Facial Transplantation / Q000009:adverse effects / Q000191:economics*; D005260:Female; D006084:Graft Rejection / Q000191:economics / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D009820:Ohio; D019651:Plastic Surgery Procedures / Q000191:economics*; D014948:Wounds, Gunshot / Q000191:economics / Q000601:surgery