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Cost of a quality‐adjusted life year in liver transplantation: The influence of the indication and the model for end‐stage liver disease score
Author(s) -
Åberg Fredrik,
Mäklin Suvi,
Räsänen Pirjo,
Roine Risto P.,
Sintonen Harri,
Koivusalo AnnaMaria,
Höckerstedt Krister,
Isoniemi Helena
Publication year - 2011
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22388
Subject(s) - medicine , liver transplantation , quality adjusted life year , liver disease , immunosuppression , transplantation , cost effectiveness , cost–utility analysis , quality of life (healthcare) , surgery , pediatrics , risk analysis (engineering) , nursing
Abstract Cost issues in liver transplantation (LT) have received increasing attention, but the cost‐utility is rarely calculated. We compared costs per quality‐adjusted life year (QALY) from the time of placement on the LT waiting list to 1 year after transplantation for 252 LT patients and to 5 years after transplantation for 81 patients. We performed separate calculations for chronic liver disease (CLD), acute liver failure (ALF), and different Model for End‐Stage Liver Disease (MELD) scores. For the estimation of QALYs, the health‐related quality of life was measured with the 15D instrument. The median costs and QALYs after LT were €141,768 and 0.895 for 1 year and €177,618 and 3.960 for 5 years, respectively. The costs of the first year were 80% of the 5‐year costs. The main cost during years 2 to 5 was immunosuppression drugs (59% of the annual costs). The cost/QALY ratio improved from €158,400/QALY at 1 year to €44,854/QALY at 5 years, and the ratio was more beneficial for CLD patients (€42,500/QALY) versus ALF patients (€63,957/QALY) and for patients with low MELD scores versus patients with high MELD scores. Although patients with CLD and MELD scores > 25 demonstrated markedly higher 5‐year costs (€228,434) than patients with MELD scores < 15 (€169,541), the cost/QALY difference was less pronounced (€59,894/QALY and €41,769/QALY, respectively). The cost/QALY ratio for LT appears favorable, but it is dependent on the assessed time period and the severity of the liver disease. Liver Transpl 17:1333–1343, 2011. © 2011 AASLD.