Cost Analysis of Conventional Face Reconstruction versus Face Transplantation for Large Tissue Defects

Background: Large facial tissue defects are traditionally treated with staged conventional reconstruction. Facial allograft transplantation has emerged as a treatment modality. Facial allografts are procured from a dead donor and transplanted to the recipient. Recipients are then subjected to lifelong global immunosuppression to prevent immunologic rejection. This study analyzes the cost of facial allograft transplantation in comparison with conventional reconstruction. Methods: Hospital billing records from facial allograft transplantation (2009 to 2011) and conventional reconstruction (2000 to 2010) patients were compiled. Comparative 1-year costs were calculated, segregated by physician, hospital, and hospital's department costs. Because most conventional reconstruction patients had smaller facial deficits than their facial allograft transplantation counterparts, regression models were used to estimate costs of conventional reconstruction for full facial defects, mirroring the facial transplantation cohort. All costs were adjusted using the medical consumer price index. Results: One-year costs for facial allograft transplantation were significantly higher than those for conventional reconstruction (mean/median, $337,360/$313,068 versus $70,230/$64,451, respectively). One-year costs for a hypothetical full-face conventional reconstruction were $184,061 (95 percent CI, $89,358 to $278,763). The per-patient cost in a hypothetical cohort of conventional reconstruction patients with deficits identical to four facial allograft transplantation recipients was $155,475 (95 percent CI, $69,021 to $241,929). Conclusions: Initial cost comparison portrays facial allograft transplantation as significantly more costly than conventional reconstruction. However, after adjustments for case severity, the cost profiles are similar. Gains in efficiency and experience are expected to lower costs. Additional unmeasured benefits may also positively influence the cost-to-benefit ratio of facial allograft transplantation.