Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

Abstract

Background: Intestinal Transplantation (ITx) is the most expensive abdominal organ transplant. Detailed studies about exact costs and cost-effectiveness compared to home parenteral nutrition (HPN) therapy in chronic intestinal failure (CIF) are lacking. The aim is to provide an in-depth analysis of ITx costs and evaluate cost-effectiveness compared to HPN. Methods: To calculate costs before and after ITx, costs were analyzed in 12 adult patients. To calculate costs of patients with uncomplicated CIF, 28 adult, stable HPN patients were studied. Total costs including surgery, admissions, diagnostics, HPN therapy, medication, and ambulatory care were included. Median (range) costs are given. Results: Costs prior to ITx were €69 160 (60 682-90 891) in year 2, and €104 146 (83 854-186 412) in year 1. After ITx, costs were €172 133 (122 483 -351 407) in the 1 st year, €40 619 (3 905 -113 154) in the 2 nd year, and dropped to €15 743 (4 408 -138 906) in the 3 rd year. In stable HPN patients, the costs were €83 402 (35 364 -169 146) in the 1 st year, €70 945 (31 955 -117 913) in the 2 nd year, and stabilized to €60 242 (29 161-238 136) in the 3 rd year. Conclusion:ITx, although initially very expensive, is cost-effective compared to HPN in adults by year 4, and cost saving by year 5.

Pediatric intestine transplant cost: Analysis of the Pediatric Health Information System database

“…After transplant, hospitalization costs decreased each year during the first 3 years. These results mirror what has been reported in a Belgian adult cohort 14 . Although median hospitalization costs up to 3 years after transplant seemed to be higher than pretransplant costs, this only represents a portion of the total healthcare for expenditure for these children.…”

“…These results mirror what has been reported in a Belgian adult cohort. 14 Although median hospitalization costs up to 3 years after transplant seemed to be higher than pretransplant costs, this only represents a portion of the total healthcare for expenditure for these children. Home parenteral nutrition alone has yearly costs estimated to exceed $150,000, 15 and yearly maintenance immunosuppression costs after transplant have been estimated as $12,000 for renal transplant.…”

Intestinal Donation and Utilization: Single-Center Analysis Within Eurotransplant

“…Median weight was 50 kg . BMI was 19.6 kg/m 2 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). BMI was higher than the predefined maximum of 25 kg/ m 2 in one donor.…”

“…In three donors, CPR had been performed for 20 min (10-30) and cardiac arrest time in these donors was 25 min (5-45). Hypotensive episodes of 10 min were noted in two donors (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Norepinephrine was used at a dosage of 0.1 μg/kg/min (γ) (0.0155-0.68) as single inotropic in 13 donors and in combination in 2 others.…”

Intestinal transplantation: an update

“…However, most patients are weaned off parenteral nutrition before discharge. It has been shown that ITx is cost-saving compared to PN in the medium to long term (5 years) [37 ▪ ].…”