Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups

Abstract

on behalf of the CELT Project TeamLiver transplantation has never been the subject of a randomized controlled trial, and there remains uncertainty about the magnitude of benefit and cost-effectiveness for specific patient groups. This article reports the results of an economic evaluation of adult liver transplantation in England and Wales. Patients placed on the waiting list for a liver transplant were observed over 27 months. The costs and health benefits of a comparison group, representing experience in the absence of liver transplantation, were estimated using a combination of observed data from patients waiting for a transplant and published prognostic models. The analysis focuses on three disease groups, for each of which prognostic models were available: primary biliary cirrhosis (PBC), alcoholic liver disease (ALD), and primary sclerosing cholangitis (PSC). A higher proportion of patients with ALD were assessed for a transplant but not placed on the waiting list. The estimated gain in quality-adjusted life-years from transplantation was positive for each of the disease groups. The mean incremental cost per quality-adjusted life-year (95% bootstrap confidence intervals) from time of listing to 27 months for patients with PBC, ALD, and PSC are £29,000 (£1,000 to £59,000), £48,000 (£12,000 to £83,000) and £21,000 (؊£23,000 to £60,000), respectively. In conclusion, liver transplantation increases the survival and health-related quality of life of patients with each of three end-stage liver diseases. However, the extent of this increase differs between different disease groups. Cost-effectiveness estimates were poorer for patients with ALD over the 27-month period than for patients with PBC or PSC. This in part reflects the costs of the higher number of ALD patients assessed for each transplant. (Liver Transpl 2003; 9:1295-1307.)

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

“…The cost of quality-adjusted life years that are gained with LT is generally $35,000 to $125,000 105 ; the cost range for living donor LT is even lower. 106 According to the available data, there is sufficient evidence to establish the MC as the main factor for determining the prognosis after LT. Through the determination of the tumor size and number, the MC currently represent the most reliable composite factor for assessing HCC morphology with respect to patient allocation for transplantation.…”

Economic Evaluations of Organ Transplantations - A Systematic Literature Review

“…Studer et al 2004). Although most studies present sample characteristics, only a few estimate different cost-effectiveness ratios for different subgroups, including Longworth et al (2003) for three different diseases and Jassal et al (2003) for age and comorbidity. This limitation in earlier studies is probably due to a low number of transplantations being performed, which limits the sample and thus renders subgroup estimations insecure.…”

“…The follow-up is relatively short in some of the published studies (e.g. Longworth et al (2003); Northup et al (2009)), especially when considering a societal perspective. In addition to this, it is also important that future studies should accurately capture the effect on living donors, again with a long follow-up period.…”

The Role of Liver Transplantation in theTreatment of Alcoholic Liver Disease

“…In an attempt to answer this question a study from England and Wales attempted an economic evaluation of liver transplantation in that area (Longworth et al, 2003). Cost-effectiveness was measured using incremental cost per quality-adjusted life years (QALY; commonly referred to as cost-utility analysis).…”