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Same quality – higher price? The paradox of allocation: the first national single center analysis after the implementation of the new Swiss transplantation law: the ICU view
Author(s) -
Oberkofler Christian E.,
Stocker Reto,
Raptis Dimitri A.,
Stover John F.,
Schuepbach Reto A.,
Müllhaupt Beat,
Dutkowski Philipp,
Clavien PierreAlain,
Béchir Markus
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2010.01364.x
Subject(s) - medicine , transplantation , center (category theory) , quality (philosophy) , single center , intensive care medicine , emergency medicine , surgery , philosophy , chemistry , epistemology , crystallography
Oberkofler CE, Stocker R, Raptis DA, Stover JF, Schuepbach RA, Müllhaupt B, Dutkowski P, Clavien P‐A, Béchir M. Same quality – higher price? The paradox of allocation: the first national single center analysis after the implementation of the new Swiss transplantation law: the ICU view.
Clin Transplant 2011: 25: 921–928. © 2010 John Wiley & Sons A/S. Abstract: This study was undertaken as the first national single‐center analysis to assess the impact of the new Swiss transplantation law on patient selection, intensive care unit (ICU) complications, outcome, and, in particular, costs in liver transplant recipients treated in our surgical ICU. The first 35 consecutive liver transplant recipients following the new act were compared with the last 35 liver transplant recipients preceding July 1, 2007. Following execution of the new law, recipients were in poorer condition, reflected by significant higher Model for End‐Stage Liver Disease (MELD) scores (12 vs. 22; p = 0.006). Furthermore, the MELD group obtained more renal replacement therapies (40.0% vs. 14.3%; p = 0.015). Cumulative one‐yr patient survival was comparable in both groups (91.4% vs. 80.1%, p = 0.22). Finally, the additional costs per single case increased 27 000 Euros after the adoption of the new law. Our data serve as an example that political decisions influence patient’s selection, and, in turn, complications, finally leading to higher costs of medical treatment. Liver graft allocation according to the MELD system may save lives at the price of increased intensive care efforts.