Cost-Effectiveness of Free Tissue Transfer for Unilateral Facial Paralysis.

OBJECTIVE

To determine the cost-effectiveness of single-stage free tissue transfer techniques as compared to no intervention for the treatment of chronic facial paralysis.

METHODS

The health utility values specific to unilateral facial paralysis and post-facial reanimation, as well as the cost and success rate of free tissue transfer, were derived from the published literature. Decision tree modeling with Monte Carlo simulation was used to calculate cost-effectiveness. A sensitivity analysis tested the validity of the conclusions by modeling variations in cost and utility values.

RESULTS

The surgical pathway is $141,277 more costly and 2.49 quality-adjusted life years (QALY) more effective than no intervention. The incremental cost-effectiveness ratio between the two pathways is $56,737.80/QALY. At a willingness to pay (WTP) threshold of $100,000 and $150,000, the surgery is cost-effective across all parameters tested (maximum cost end-point being $180,000).

CONCLUSION

Despite the imperfect success rate and risks involved, free tissue transfer surgery is a cost-effective treatment for facial paralysis as compared to no intervention.