The cost effectiveness of lung transplantation compared with that of heart and liver transplantation in the Netherlands

Abstract

This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost-effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are based on three Dutch technology assessments of transplantation, with minor adjustments for time and methods. In result, mainly follow-up costs of lung transplantation are higher than costs of heart and liver transplantation -US $1 50,300, US $121,500, and US $95,300, respectively -in the first 3 years after transplantation. The survival gain realized by lung transplantation is small (4.4 years) compared with heart (8.8 years) and liver (14.7years) transplantation. Costs per life-year gained were US $77,000, US $38,000, and US $26,000 for lung, heart, and liver transplantation, respectively. The unfavorable cost effectiveness of lung transplantation is largely related to a relatively small survival gain and high follow-up costs.

Lung Transplantation in Patients With Chronic Obstructive Pulmonary Disease in a National Cohort Is Without Obvious Survival Benefit

“…However, the procedure is effective, and has a high cost and a high cost per quality-adjusted lifeyear. 38,39 The finding of no survival benefit of lung transplantation in COPD/emphysema in the present study, combined with the mixed nature of previous evidence, suggests that if no sub-group that benefits from the procedure can be identified, then a randomized, controlled trial of lung transplantation for COPD/emphysema might be considered. However, several studies have shown an improvement in quality of life in survivors of lung transplantation, 5-8 which might be considered as important as survival.…”

Cost-effectiveness of Pediatric Heart Transplantation

“…15 Ouwens et al showed that heart transplantation costs approximately $46,000 (1992 prices) per QALY gained for adults in Holland. 5 After adjusting to 2004 dollars, adult transplant costs almost $62,000 per QALY gained. 15 It is of interest to note that, despite relatively favorable cost-utility of adult heart transplantation, access to heart transplantation for many adults in the USA is limited due to lack of coverage under state Medicaid programs.…”

“…4 In addition, data from adults suggest that the quality-of-life measure (utility) is severely diminished in those with advanced heart failure. 5 The number of QALYs gained by conservative therapy, therefore, was estimated to be 0.12. As such, for the purposes of this study, we assumed that quality-adjusted survival time for children with end-stage heart failure not offered transplantation would be negligible.…”

Despair Over Disparities

“…The decision was driven purely by cost, without consideration of effectiveness. Although robust analyses of cost-effectiveness for heart transplantation are lacking, those analyses which have been done (4,5) support the view that these procedures fall well within the accepted cost-effective range, rendering the Arizona decision irrational. Beyond coverage decisions, payers within a fee-for-service model must reimburse costeffective procedures at levels that at least cover cost.…”