title: The utility of hand transplantation in hand amputee patients.
abstract: OBJECTIVE
  To measure the desirable health outcome, termed utility, and the expected quality-adjusted life years (QALYs) gained with hand composite tissue allotransplantation (CTA) using hand amputee patients and the general public.
  
  
  METHODS
  Using the standard gamble (SG) and time trade-off (TTO) techniques, utilities were obtained from 30 general public participants and 12 amputee patients. The health utility and net QALYs gained or lost with transplantation were computed. A sensitivity analysis was conducted to account for the effects of lifelong immunosuppression on the life expectancy of transplant recipients. Higher scores represent greater utility.
  
  
  RESULTS
  Hand amputation mean health utility as measured by the SG and TTO methods, respectively, was 0.72 and 0.80 for the general public and 0.69 and 0.70 for hand amputees. In comparison, hand CTA mean health utility was 0.74 and 0.82 for the general public and 0.83 and 0.86 for amputees. Hand CTA imparted an expected gain of 0.9 QALYs (SG and TTO) in the general public and 7.0 (TTO) and 7.8 (SG) QALYs in hand amputees. A loss of at least 1.7 QALYs was demonstrated when decreasing the life expectancy in the sensitivity analysis in the hand amputee group.
  
  
  CONCLUSIONS
  Hand amputee patients did not show a preference toward hand CTA with its inherent risks. With this procedure being increasingly adopted worldwide, the benefits must be carefully weighed against the risks of lifelong immunosuppressive therapy. This study does not show clear benefit to advocate hand CTA.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Noor
authors.initials: N
authors.lastname: Alolabi
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chuback
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Grad
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Electronic address: athoma@mcmaster.ca.
authors.forename: Achilles
authors.initials: A
authors.lastname: Thoma
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D000674:Amputees; D003661:Decision Support Techniques; D005260:Female; D006225:Hand / Q000601:surgery*; D063987:Hand Transplantation / Q000009:adverse effects; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Composite tissue allotransplantation; decision analysis; hand transplant; quality-adjusted life years; time trade-off