Economic Evaluations of Organ Transplantations - A Systematic Literature Review

Abstract

Abstract:The purpose of this study is threefold; 1) to establish the current level of knowledge regarding cost-effectiveness of organ transplantation, 2) to identify knowledge gaps, and 3) to suggest a framework for future studies. A systematic literature review of economic evaluations of transplantations of solid organs was conducted in October 2010. Economic evaluations published since 2000 and reviews published since 1987 for kidney, liver, lung, heart, pancreas, and small bowel transplantations were collected. The studies were analysed regarding results and study characteristics. The review demonstrates a lack of economic evaluations for all included organ transplantations. The cost-effectiveness of kidney transplantation, and to some extent liver transplantation, compared to a nontransplant alternative appears to be established. However, cost-effectiveness for transplantation of lung, heart, pancreas, and small bowel can neither be established nor rejected based on earlier studies. Many of the included studies were limited in a number of ways; e.g. using short follow-up period, failing to account for sample selection in treatment groups, comparing to unrealistic alternatives, lacking important cost categories, and using a limiting perspective. Recommendation for future studies are, besides accounting for the above, to conduct sub-group analyses as patient and disease characteristics, among other things, has been shown to affect the cost-effectiveness of organ transplantation.

A personalized follow-up of kidney transplant recipients using video conferencing based on a 1-year scoring system predictive of long term graft failure (TELEGRAFT study): protocol for a randomized controlled trial

“…The cost-effectiveness of renal transplantation for ESRD patients is well-established compared to long-term dialysis [ 16 – 18 ]. Nevertheless, because the follow-up of the kidney transplant recipient is often performed at hospitals several times per year, is often coupled with significant travel requirements, long queue times and the stress associated with medical examinations, this places a measureable increase in costs and may impact the recipient’s QoL.…”

From Hesitation to Appreciation: the transformation of a single, local donation‐nurse project into an established organ‐donation service

“…The DOSS service costs approximately 190 000 euro per year, which is cost‐effective considering the substantial increase of donors it produces—accordingly, more patients are being transplanted. Beside the financial benefits, there are also personal benefits ranging from organ recipients gaining a much improved quality of life to recipients being saved from life threatening conditions .…”

A European perspective of the cost effectiveness of facial composite tissue allotransplantation

“…In the UK, solid organ transplantation is the treatment of choice for patients with serious organ pathology, with procedure costs ranging from £34,000 for a pancreatic islet transplant to £240,500 for an adult heart transplant [13]. Though expensive and complex, transplantation is undeniably lifetransforming: various analyses reporting cost per QALY (quality adjusted life year) conclude that the benefits from transplantation outweigh the expenses [13][14][15][16]. Furthermore, depending on the organ transplanted, there can be a concomitant financial benefit for the procedure.…”