Cost and clinical outcome of islet transplantation in Norway 2010‐2015

Abstract

Islet transplantation is a minimally invasive β-cell replacement strategy. Islet transplantation is a reimbursed treatment in Norway. Here, we summarize the cost and clinical outcome of 31 islet transplantations performed at Oslo University Hospital (OUS) from January 2010 to June 2015. Patients were retrospectively divided into three groups. Thirteen patients received either one or two islet transplantation alone (ITA), while five patients received islet transplantation after previous solid organ transplantation. For the group receiving 2 ITA, Kaplan-Meier estimates show an insulin independence of 20% more than 4 years after their last transplantation. An estimated 70% maintain at least partial graft function, defined as fasting C-peptide >0.1 nmol L , and 47% maintain a HbA1c below 6.5% or 2 percent points lower than before ITA. For all groups combined, we estimate that 44% of the patients have a 50% reduction in insulin requirement 4 years after the initial islet transplantation. The average cost for an islet transplantation procedure was 347 297±60 588 NOK, or 35 424±6182 EUR, of which isolation expenses represent 34%. We hereby add to the common pool of growing experience with islet transplantation and also describe the cost of the treatment at our center.

Calcium

“…The rate of clinical islet transplantations is envisioned to increase substantially if a Ca 2+ concentration optimal for enzyme activity is applied. From a health care and insurance perspective, the increased rate of transplantation itself should translate to a substantial improvement in the cost–benefit of islet transplantation 18 . Furthermore, potentiation of the enzyme blend by Ca 2+ supplementation may allow the use of lower quantities of enzymes during human islet isolation, further reducing the cost of clinical islet isolation.…”

The Future of Clinical Islet Transplantation in the United States

“…If two infusions are necessary the expense of pancreas procurement and islet isolation are doubled again. Pancreas procurement can cost upwards of $100,000 per organ and reports from European centers estimate the costs of islet isolation at 30-35% of the cost of the entire procedure [78,81]. The expenses attributed to the failure of islet isolation to provide islets for Tx and the need for multiple infusions can easily double the cost of islet Tx, perhaps as much as $600,000 total.…”

Economics of Beta-Cell Replacement Therapy

“…The costs of islet cell transplantation in other countries, where the procedure is standard of care, are lower. A value of 347,297 NOK (US $41,675) per islet cell transplant was reported in Norway [26]. In Canada, average costs of 94,765 CAD (US $71,073) were estimated [27].…”