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Faris C, Tessler O, Heiser A, Hadlock T, Jowett N. Evaluation of Societal Health Utility of Facial Palsy and Facial Reanimation. JAMA FACIAL PLAST SU 2019; 20:480-487. [PMID: 30178066 DOI: 10.1001/jamafacial.2018.0866] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The severity of a health state may be quantified using health utility measures. The utility of flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome with synkinesis may be challenging to discern from photographs alone. Objective To determine the societal health utility of flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, and post-facial reanimation using standard video. Design, Setting, and Participants This survey study was conducted at the Massachusetts Eye and Ear and the Harvard Decision Science Laboratory from June 14, 2017, to August 3, 2017. Healthy adult naïve observers were recruited through advertising in the Cambridge, Massachusetts, area. Participants (n = 298) completed the web-based, interactive survey in person. The survey comprised clinical vignettes consisting of symptom summaries, videos, and pictures depicting 5 health states. Main Outcomes and Measures Adult naïve observers ranked the utility of 5 randomized health states (flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, post-facial reanimation, monocular blindness, and binocular blindness) according to the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) measures. Standard videos of patients' facial function were used. Results In total, 377 naïve observers were recruited and completed the survey in its entirety. Of the 377 participants, 298 (79.0%) were included for analysis. Among the 298 participants, 151 (50.7%) were female, 146 (49.0%) were male, with a mean (SD) age of 33.0 (15.1) years. No differences in health utility scores (SD) were observed between flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome (VAS: 0.598 [0.213] vs 0.629 [0.207]; SG: 0.714 [0.245] vs 0.748 [0.237]; TTO: 0.716 [0.248] vs 0.741 [0.247]). Both health states rated substantially worse than monocular blindness (VAS: 0.691 [0.212]; SG: 0.817 [0.204]; TTO: 0.826 [0.196]) and post-facial reanimation (VAS: 0.742 [0.189]; SG: 0.833 [0.206]; TTO: 0.838 [0.19]). Conclusions and Relevance Health utility scores for flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome appeared to be equivalent and worse than that for monocular blindness, whereas scores for post-facial reanimation were substantially higher than the scores for the 2 facial movement disorders. These findings may provide insights into the societal advantages of facial reanimation surgery. Level of Evidence NA.
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Affiliation(s)
- Callum Faris
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Head and Neck Surgery, Tübingen University, Tübingen, Germany
| | - Oren Tessler
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Alyssa Heiser
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Tessa Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Nate Jowett
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
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Li YK, Alolabi N, Kaur MN, Thoma A. A systematic review of utilities in hand surgery literature. J Hand Surg Am 2015; 40:997-1005. [PMID: 25771479 DOI: 10.1016/j.jhsa.2015.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the literature to determine if utilities (a quantitative way to express patient preferences for health outcomes) have been measured in hand surgery studies. METHODS A literature search was conducted using Cochrane, EMBASE, HealthSTAR, MEDLINE, and CINAHL electronic databases (1966-2013). This search was supplemented by cited and manual reference searches and expert consultation to retrieve all relevant studies. Studies were selected by 2 independent reviewers if they pertained to hand or wrist surgery, were published in English, and measured utilities as an outcome. Descriptive data were extracted, including the hand surgery procedure investigated, study design, value of utilities, and methodology of utilities measurement. RESULTS Eleven studies were included after reviewing 989 studies. Most hand conditions were associated with utilities less than 0.8. Utilities in the reviewed studies were measured using different methods and from different subjects. Three studies paradoxically mapped greater utilities for poorer heath states. CONCLUSIONS Hand conditions cause impairment, as evidenced by their utilities. Measurement of utilities remains uncommon in hand surgery literature. Future studies should not only measure utilities but also do so with consistent and appropriate methodology to ensure that mapped values are valid and comparable. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/decision analysis III.
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Affiliation(s)
- Yu Kit Li
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Noor Alolabi
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manraj Nirmal Kaur
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Surgical Outcomes Research Centre, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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Araújo CDM, Veiga DF, Hochman BS, Abla LEF, Oliveira ACS, Novo NF, Veiga-Filho J, Ferreira LM. Cost-utility of reduction mammaplasty assessed for the Brazilian public health system. Aesthet Surg J 2014; 34:1198-204. [PMID: 24973340 DOI: 10.1177/1090820x14539972] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Economic evaluation is important for making decisions about resource allocation. Few cost-utility or cost-effectiveness studies on breast hypertrophy have been reported in the medical literature. OBJECTIVES The authors sought to determine the cost-utility of reduction mammaplasty in the Brazilian national health care system. METHODS This randomized controlled study was conducted in a university-affiliated hospital. Sixty patients with breast hypertrophy were enrolled prospectively and were assigned randomly to either the control group (n = 30 patients who received follow-up for 6 months) or the treatment group (n = 30 patients who underwent reduction mammaplasty). Direct costs were recorded, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to both groups at the beginning of the study (preoperatively for the treatment group) and 3 and 6 months postoperatively. Utility was determined with Instrument 6D of the Brazilian version of the Short-Form Health Survey (SF-6D), from the SF-36 data. RESULTS At the 6-month follow-up, the treatment group showed an improvement in utility, with an average direct cost of approximately £104. CONCLUSIONS Reduction mammaplasty performed in the Brazilian national health care system provides a cost-utility ratio equivalent to approximately £142 per 1 quality-adjusted life year.
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Affiliation(s)
- Carlos Delano Mundim Araújo
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Daniela Francescato Veiga
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Bernardo Sérgio Hochman
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Luiz Eduardo Felipe Abla
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Salles Oliveira
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Neil Ferreira Novo
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Joel Veiga-Filho
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
| | - Lydia Masako Ferreira
- Dr Araújo is a Preceptor in the Division of Orthopedics, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga is an Associate Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil, and is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDrs Hochman and Abla are Associate Professors of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, BrazilDr Oliveira is a medical student at the School of Medicine, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Novo is a Full Professor in the Department of Biostatistics, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Veiga-Filho is an Associate Professor in the Division of Plastic Surgery, Department of Surgery, University of Vale do Sapucaí, Pouso Alegre, BrazilDr Ferreira is a Full Professor of the Plastic Surgery Postgraduate Program, Federal University of São Paulo, São Paulo, Brazil
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