Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost
Patrick G Northup, Michael M Abecassis, Michael J Englesbe, Jean C Emond, Vanessa D Lee, George J Stukenborg, Lan Tong, Carl L Berg, Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group, Jean C Emond, Robert S Brown Jr, Rudina Odeh-Ramadan, Scott Heese, Michael M I Abecassis, Andreas Blei, Patrice Al-Saden, Abraham Shaked, Kim M Olthoff, Mary Kaminski, Mary Shaw, James F Trotter, Igal Kam, Carlos Garcia, Ronald W Busuttil, Sammy Saab, Janet Mooney, Chris E Freise, Norah A Terrault, Dulce MacLeod, Robert M Merion, Anna S F Lok, Akinlolu O Ojo, Brenda W Gillespie, Margaret Hill-Callahan, Terese Howell, Lan Tong, Tempie H Shearon, Karen A Wisniewski, Monique Lowe, Paul H Hayashi, Carrie A Nielsen, Carl L Berg, Timothy L Pruett, Jaye Davis, Robert A Fisher, Mitchell L Shiffman, Ede Fenick, April Ashworth, James E Everhart, Leonard B Seeff, Patricia R Robuck, Jay H Hoofnagle, Patrick G Northup, Michael M Abecassis, Michael J Englesbe, Jean C Emond, Vanessa D Lee, George J Stukenborg, Lan Tong, Carl L Berg, Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group, Jean C Emond, Robert S Brown Jr, Rudina Odeh-Ramadan, Scott Heese, Michael M I Abecassis, Andreas Blei, Patrice Al-Saden, Abraham Shaked, Kim M Olthoff, Mary Kaminski, Mary Shaw, James F Trotter, Igal Kam, Carlos Garcia, Ronald W Busuttil, Sammy Saab, Janet Mooney, Chris E Freise, Norah A Terrault, Dulce MacLeod, Robert M Merion, Anna S F Lok, Akinlolu O Ojo, Brenda W Gillespie, Margaret Hill-Callahan, Terese Howell, Lan Tong, Tempie H Shearon, Karen A Wisniewski, Monique Lowe, Paul H Hayashi, Carrie A Nielsen, Carl L Berg, Timothy L Pruett, Jaye Davis, Robert A Fisher, Mitchell L Shiffman, Ede Fenick, April Ashworth, James E Everhart, Leonard B Seeff, Patricia R Robuck, Jay H Hoofnagle
Abstract
Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality-adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4-QALY survival and a mean cost of $151,613, and waiting list with possible DDLT or LDLT offered 4.9-QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost-effectiveness ratio (ICER) of $35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost-effective compared to medical management of cirrhosis over our 10-year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost.
(c) 2009 AASLD.
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Source: PubMed