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

57 Scopus citations

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

All Science Journal Classification (ASJC) codes

  • Transplantation

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    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