Cost-utility analysis of normothermic liver perfusion with the OrganOx metra compared to static cold storage in the United Kingdom

Abstract

Background: Rising numbers of patients on the liver transplant waiting list has led to the utilization of organs from higher-risk donors that are more likely to be discarded and are prone to post-transplant complications. Storage and transportation of these livers at low temperatures can cause damage. OrganOx metra is a portable device intended to preserve and maintain the donated liver in normothermic conditions for up to 24 h prior to transplantation. Objective: To evaluate the cost-utility of normothermic machine perfusion with OrganOx metra in liver transplantation compared to the current practice of static cold storage (SCS). Methods: A de novo decision analytic model (a decision tree along with a Markov model), based on current treatment pathways, was developed to estimate the costs and outcomes. Results from a randomized clinical trial and national standard sources were used to inform the model. Costs were estimated from the National Health Service and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to explore uncertainty surrounding input parameters. Results: Over a lifetime time horizon, liver transplantation with OrganOx metra was more costly and more effective than the current practice of static cold storage. The total costs per patient were £37,370 vs £46,711, and the total effectiveness per patient was 9.09 QALYs vs 10.27 QALYs for SCS and OrganOx metra groups, respectively. The estimated ICER was £7,876 per each QALY gained. Results from the PSA showed that use of OrganOx metra has 99% probability of being cost-effective at a £20,000 willingness-to-pay threshold. OrganOx metra led to the utilization of 54 additional livers with patients experiencing lower rates of early allograft dysfunction and adverse events. Conclusions: Use of OrganOx metra for the perfusion and transportation of livers prior to transplantation is a cost-effective strategy.

Cost-utility analysis of normothermic machine perfusion compared to static cold storage in liver transplantation in the Canadian setting

“…The model was based on an RCT, which induces bias as the study population is required to fit specific inclusion criteria and results may not be reflective of the entire population awaiting liver transplantation. Their study applies a lifetime horizon: however, it does not model important outcomes that would be expected over that timeframe, such as hepatic artery thrombosis, ischemic cholangiopathy, or primary non‐function 19 . The approach for our model was a more real‐world comparison of two transplant program strategies rather than individual transplantation approaches: it is unlikely that a center would apply NMP to all grafts, rather than to select ones.…”

“…19 Their CUA showed the OrganOx machine to be a cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of £7876 per quality-adjusted life year (QALY) gained with a 99% probability of being cost-effective at a willingness-to-pay (WTP) threshold of £20 000 in 2018 pounds sterling over a lifetime horizon. 19 This equates to an ICER of $11 465 (2021 US$) and a WTP threshold of $29 114. 17,18,20 It is important to assess the cost-effectiveness of adding the OrganOx machine to a transplant program rather than the OrganOx machine on its own.…”

The economic impact of machine perfusion technology in liver transplantation

“…Recently, a cost‐effectiveness evaluation was performed encompassing the results of the first RCT on liver transplantation with NMP and national standard sources in the United Kingdom 6,22 . A de novo decision‐analytic model was developed to estimate the costs and outcomes in each strategy over a lifetime time horizon.…”

“…A de novo decision‐analytic model was developed to estimate the costs and outcomes in each strategy over a lifetime time horizon. Additional costs related to the OrganOx device were the costs of disposables and solutions (£6000 [US$8160]), staff costs (£500 [US$680]), and a device lease fee of £30 000 (US$40 800) per year per hospital 22 . Costs of follow‐up care, immunosuppressants, and visits to specialists and general doctors for follow‐up after transplantation were also considered.…”

Maschinenperfusion in der Lebertransplantation – was ist möglich und wo stehen wir in Deutschland? Übersicht der Literatur und Ergebnisse einer nationalen Umfrage

“…Den unterschiedlichen Formen der Maschinenperfusion gemein ist die Verringerung des immanenten Ischämie-Reperfusions-Schadens durch die Gewährleistung eines kontinuierlichen vaskulären Flusses, der zudem eine potenzielle Evaluation der Organfunktion ex vivo ermöglicht und somit die Nutzbarkeit gerade von ECD-Organen potenziell optimieren kann. Daher wird die Maschinenperfusion bereits jetzt als einer der wichtigsten Fortschritte in der Transplantationsmedizin eingestuft [18], jedoch ist der optimale Einsatz dieser Konservierungsstrategie weiterhin Gegenstand kritischer Diskussionen, insbesondere im Kontext der nicht unerheblichen Kosten, die mit dem flächendeckenden Einsatz einer solchen Technologie verbunden sind [19].…”