Cost-effectiveness of cadaveric and living-donor liver transplantation

Markus Sagmeister, Beat Mullhaupt, Zakiyah Kadry, Gerd A. Kullak-Ublick, Pierre A. Clavien, Eberhard L. Renner

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background. Cadaveric liver transplantation (5-year survival >80%) represents the standard of care for end-stage liver disease (ESLD). Because the demand for cadaveric organs exceeds their availability, living-donor liver transplantation has gained increasing acceptance. Our aim was to assess the marginal cost-effectiveness of cadaveric and living-donor orthotopic liver transplantation (OLT) in adults with ESLD. Methods. Using a Markov model, outcomes and costs of ESLD treated (1) conservatively, (2) with cadaveric OLT alone, and (3) with cadaveric OLT or living-donor OLT were computed. The model was validated with published data. The case-based scenario consisted of data on all 15 ESLD patients currently on our waiting list (3 women, 12 men; median age, 48 years [range, 33-59 years]) and on the outcome of all OLT performed for ESLD at our institution since 1995 (n=51; actuarial 5-year survival 93%). Living-donor OLT was allowed in 15% during the first year of listing; fulminant hepatic failure and hepatocellular carcinoma were excluded. Results. Cadaveric OLT gained on average 6.2 quality-adjusted life-years (QALYs) per patient compared with conservative treatment, living-donor OLT, an additional 1.3 QALYs compared with cadaveric OLT alone. Marginal cost-effectiveness of a program with cadaveric OLT alone and a program with cadaveric and living-donor OLT combined were similar (€ 22,451 and € 23,530 per QALY gained). Results were sensitive to recipient age and postoperative survival rate. Conclusions. Offering living-donor OLT in addition to cadaveric OLT improves survival at costs comparable to accepted therapies in medicine. Cadaveric OLT and living-donor OLT are cost-effective.

Original languageEnglish (US)
Pages (from-to)616-622
Number of pages7
JournalTransplantation
Volume73
Issue number4
DOIs
StatePublished - Feb 27 2002

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Living Donors
Liver Transplantation
Cost-Benefit Analysis
Economics
End Stage Liver Disease
Quality-Adjusted Life Years
Costs and Cost Analysis
Survival
Waiting Lists
Acute Liver Failure
Standard of Care

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Sagmeister, M., Mullhaupt, B., Kadry, Z., Kullak-Ublick, G. A., Clavien, P. A., & Renner, E. L. (2002). Cost-effectiveness of cadaveric and living-donor liver transplantation. Transplantation, 73(4), 616-622. https://doi.org/10.1097/00007890-200202270-00025
Sagmeister, Markus ; Mullhaupt, Beat ; Kadry, Zakiyah ; Kullak-Ublick, Gerd A. ; Clavien, Pierre A. ; Renner, Eberhard L. / Cost-effectiveness of cadaveric and living-donor liver transplantation. In: Transplantation. 2002 ; Vol. 73, No. 4. pp. 616-622.
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Sagmeister, M, Mullhaupt, B, Kadry, Z, Kullak-Ublick, GA, Clavien, PA & Renner, EL 2002, 'Cost-effectiveness of cadaveric and living-donor liver transplantation', Transplantation, vol. 73, no. 4, pp. 616-622. https://doi.org/10.1097/00007890-200202270-00025

Cost-effectiveness of cadaveric and living-donor liver transplantation. / Sagmeister, Markus; Mullhaupt, Beat; Kadry, Zakiyah; Kullak-Ublick, Gerd A.; Clavien, Pierre A.; Renner, Eberhard L.

In: Transplantation, Vol. 73, No. 4, 27.02.2002, p. 616-622.

Research output: Contribution to journalArticle

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T1 - Cost-effectiveness of cadaveric and living-donor liver transplantation

AU - Sagmeister, Markus

AU - Mullhaupt, Beat

AU - Kadry, Zakiyah

AU - Kullak-Ublick, Gerd A.

AU - Clavien, Pierre A.

AU - Renner, Eberhard L.

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Y1 - 2002/2/27

N2 - Background. Cadaveric liver transplantation (5-year survival >80%) represents the standard of care for end-stage liver disease (ESLD). Because the demand for cadaveric organs exceeds their availability, living-donor liver transplantation has gained increasing acceptance. Our aim was to assess the marginal cost-effectiveness of cadaveric and living-donor orthotopic liver transplantation (OLT) in adults with ESLD. Methods. Using a Markov model, outcomes and costs of ESLD treated (1) conservatively, (2) with cadaveric OLT alone, and (3) with cadaveric OLT or living-donor OLT were computed. The model was validated with published data. The case-based scenario consisted of data on all 15 ESLD patients currently on our waiting list (3 women, 12 men; median age, 48 years [range, 33-59 years]) and on the outcome of all OLT performed for ESLD at our institution since 1995 (n=51; actuarial 5-year survival 93%). Living-donor OLT was allowed in 15% during the first year of listing; fulminant hepatic failure and hepatocellular carcinoma were excluded. Results. Cadaveric OLT gained on average 6.2 quality-adjusted life-years (QALYs) per patient compared with conservative treatment, living-donor OLT, an additional 1.3 QALYs compared with cadaveric OLT alone. Marginal cost-effectiveness of a program with cadaveric OLT alone and a program with cadaveric and living-donor OLT combined were similar (€ 22,451 and € 23,530 per QALY gained). Results were sensitive to recipient age and postoperative survival rate. Conclusions. Offering living-donor OLT in addition to cadaveric OLT improves survival at costs comparable to accepted therapies in medicine. Cadaveric OLT and living-donor OLT are cost-effective.

AB - Background. Cadaveric liver transplantation (5-year survival >80%) represents the standard of care for end-stage liver disease (ESLD). Because the demand for cadaveric organs exceeds their availability, living-donor liver transplantation has gained increasing acceptance. Our aim was to assess the marginal cost-effectiveness of cadaveric and living-donor orthotopic liver transplantation (OLT) in adults with ESLD. Methods. Using a Markov model, outcomes and costs of ESLD treated (1) conservatively, (2) with cadaveric OLT alone, and (3) with cadaveric OLT or living-donor OLT were computed. The model was validated with published data. The case-based scenario consisted of data on all 15 ESLD patients currently on our waiting list (3 women, 12 men; median age, 48 years [range, 33-59 years]) and on the outcome of all OLT performed for ESLD at our institution since 1995 (n=51; actuarial 5-year survival 93%). Living-donor OLT was allowed in 15% during the first year of listing; fulminant hepatic failure and hepatocellular carcinoma were excluded. Results. Cadaveric OLT gained on average 6.2 quality-adjusted life-years (QALYs) per patient compared with conservative treatment, living-donor OLT, an additional 1.3 QALYs compared with cadaveric OLT alone. Marginal cost-effectiveness of a program with cadaveric OLT alone and a program with cadaveric and living-donor OLT combined were similar (€ 22,451 and € 23,530 per QALY gained). Results were sensitive to recipient age and postoperative survival rate. Conclusions. Offering living-donor OLT in addition to cadaveric OLT improves survival at costs comparable to accepted therapies in medicine. Cadaveric OLT and living-donor OLT are cost-effective.

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Sagmeister M, Mullhaupt B, Kadry Z, Kullak-Ublick GA, Clavien PA, Renner EL. Cost-effectiveness of cadaveric and living-donor liver transplantation. Transplantation. 2002 Feb 27;73(4):616-622. https://doi.org/10.1097/00007890-200202270-00025