title: The health technology assessment of the compulsory accident insurance scheme of hand transplantation in Switzerland.
abstract: Recently the decision-making committee of the compulsory Swiss accident insurance scheme needed to make a basic decision as to whether to fund hand transplantation under that scheme or not. A Health Technology Assessment was commissioned to inform decision-making and gain experience with applicability of the method. The following were main findings from various domains. Compared with prosthesis fitting, the outcome of hand transplantation is satisfactory for function and sensibility. Complications due to immunosuppression are frequent, sometimes severe and potentially life-shortening. The direct medical costs over the entire life span calculated for a 35-year-old unilaterally amputated base case patient were CHF 528,600 (EUR 438,500) higher than for a prosthesis. There are challenging ethical, legal and organizational issues. The committee decided not to reimburse hand transplantation for ethical reasons. The Health Technology Assessment has been shown to be a useful tool for decision-making in the context of Swiss accident insurance.
  
  
  METHODS
  IV.
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland brgu@zhaw.ch.
authors.forename: U
authors.initials: U
authors.lastname: Brügger
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Plessow
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Hess
authors.affiliation: Medical Tariff Committee for Swiss National Accident Insurance (MTK UVG), Lucerne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Caballero
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Eichler
authors.affiliation: Department of Hand-Plastic and Reconstructive Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: V
authors.initials: V
authors.lastname: Meyer
authors.affiliation: Division of Hand and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
authors.forename: U
authors.initials: U
authors.lastname: von Wartburg
mesh_terms: D026683:Advisory Committees; D003362:Cost-Benefit Analysis; D003657:Decision Making; D063987:Hand Transplantation / Q000191:economics*; D006801:Humans; D007346:Insurance, Accident; D007349:Insurance, Health, Reimbursement; D018803:Models, Economic; D013557:Switzerland
keywords: Hand transplantation; costs; evidence-based health care; health technology assessment; immunosuppression; reimbursement