Cost Analysis of Face Transplantation

Face transplantation is a novel treatment for the most severe facial defects. This study analyzes the cost of transplantation in comparison to conventional reconstruction of the face.

Billing and medical records were queried for codes related to conventional facial reconstruction performed at a single institution over a period of 10 years.  Inclusion criteria included having a major defect (missing 50-100% of one or more facial subunits, or greater than 25% of total face surface area) and having the index reconstruction procedure performed at our institution. Additionally, face transplant recipients at our institution were included in the transplantation group. Case-specific hospital costs were obtained from internal accounting data. Provider costs were estimated using published national means for each billing code. Organ procurement fees and future immunosupression drug costs were estimated based on actual costs and anticipated future contractual costs. Primary outcomes included peri-procedure costs, one-year total costs, and two-year estimated costs. Univariate and multivariate analysis for cost drivers was performed, as well as a subset analysis for costs stratified by patient characteristics and type of injury. Because most traditional reconstruction patients had smaller facial defects than transplant patients, a generalized linear regression model was created to estimate reconstruction costs for a hypothetical patient with defects equivalent to the transplant patients. Data analysis was performed using SAS statistical software.

Among 2034 reconstruction patients examined, 72 were eligible for inclusion in the conventional reconstruction group. The transplantation group included three patients. Total one-year hospital costs, with adjustments for inflation, were $246,052, $207,158 and $69,458 for the transplant group, hypothetical reconstruction patient and conventional reconstruction group, respectively.

Costs in both groups were higher during the first month of treatment than in any other month. Among reconstruction patients, higher costs were associated with defects involving the mandible (p=0.0028), private insurance (p=0.0039), hypertension (p=0.0168), and post-operative complications (p=0.0238).

Although transplantation is significantly more costly than reconstruction, costs are comparable after adjustment for case severity. Gains in efficiency and experience are expected to lower costs of transplantation. Additionally, differences in functional and quality of life benefits between these procedures may impact the value of the resources utilized.