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Original Investigation
Nov/Dec 2018

Association of Hair Loss With Health Utility Measurements Before and After Hair Transplant Surgery in Men and Women

Author Affiliations
  • 1Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston
  • 2Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston
  • 3Department of Otorhinolaryngology, Louisiana State University School of Medicine, New Orleans
JAMA Facial Plast Surg. 2018;20(6):495-500. doi:10.1001/jamafacial.2018.1052
Key Points

Question  What is the health utility score for sex-specific alopecia and the posttransplant state?

Findings  In this prospective questionnaire study of 308 adult patients, the health utility score after hair transplant significantly improved compared with the health utility score of alopecia in both sexes. Participants were willing to undergo a 7% to 8% risk of death and trade off 7% to 9% of healthy life-years for a complete cure of their hair loss.

Meaning  Hair transplant surgery significantly increases health utility measures compared with untreated alopecia in both sexes as rated among layperson observers.

Abstract

Importance  Androgenetic alopecia is a highly prevalent condition across both sexes and can be surgically corrected through hair transplant. Health utility scores, which represent quantitative estimates of individual preferences for a given state of health, are a measure of health-related quality of life. The health utility scores for sex-specific alopecia and the posttransplant state have not previously been quantified.

Objective  To obtain health utility measurements for the objective assessment of sex-specific alopecia and hair transplant surgery and to analyze layperson perception of alopecia compared with other chronic health conditions.

Design, Setting, and Participants  A prospective clinical study was conducted from August 1 to December 31, 2017, at the Harvard Decision Science Laboratory. Adult casual observers (n = 308) completed an internet-based health utility questionnaire. Health states were presented using still patient images and a description of 5 health states, including monocular blindness, binocular blindness, male alopecia, female alopecia, and male posttransplant state.

Main Outcomes and Measures  Health utility measures of sex-specific alopecia, posttransplant state, and monocular and binocular blindness were measured by visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) in quality-adjusted life-years (QALYs). Groups were analyzed with 1-way analysis of variance and post hoc Tukey pairwise comparison.

Results  The 308 participants included 157 (51.0%) women with a mean (SD) age of 30.8 (13.5) years. Mean (SD) health utility measures included 0.85 (0.18) QALYs for the VAS, 0.93 (0.17) QALYs for the SG, and 0.93 (0.17) QALYs for the TTO in male alopecia; 0.83 (0.19) QALYs for the VAS, 0.92 (0.17) QALYs for the SG, and 0.91 (0.18) QALYs for the TTO in female alopecia; and 0.93 (0.11) QALYs for the VAS, 0.95 (0.15) QALYs for the SG, and 0.95 (0.16) QALYs for the TTO in a man in the posttransplant state. The mean (SD) health utility of monocular blindness was 0.76 (0.17) QALYs for the VAS, 0.87 (0.21) QALYs for the SG, and 0.86 (0.20) QALYs for the TTO. The health utility score for the posttransplant state was significantly improved compared with the health utility score for alopecia in both sexes (female VAS: +0.10 [95% CI, 0.06-0.14; P < .001]; male VAS, +0.08 [95% CI, 0.04-0.12; P < .001]). Hair loss in women and men demonstrated significantly lower QALYs on the VAS compared with the posttransplant state (female: −0.10 [95% CI, −0.14 to −0.06; P < .001]; male: −0.08 [95% CI, −0.12 to −0.04; P < .001]).

Conclusions and Relevance  Alopecia has a meaningful negative influence on health utility measures in both sexes. Hair transplant surgery significantly increases health utility measures compared with untreated alopecia in both sexes as rated among layperson observers.

Level of Evidence  NA.

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