title: Cost-effectiveness of lung transplantation in The Netherlands: a scenario analysis.
abstract: OBJECTIVE
  To calculate cost-effectiveness of scenarios concerning lung transplantation in The Netherlands.
  
  
  METHODS
  Microsimulation model predicting survival, quality of life, and costs with and without transplantation program, based on data of the Dutch lung transplantation program of 1990 to 1995.
  
  
  METHODS
  Netherlands, University Hospital Groningen.
  
  
  METHODS
  Included were 425 patients referred for lung transplantation, of whom 57 underwent transplantation.
  
  
  METHODS
  Lung transplantation.
  
  
  RESULTS
  For the baseline scenario, the costs per life-year gained are G 194,000 (G=Netherlands guilders) and the costs per quality-adjusted life-year (QALY) gained are G 167,000. Restricting patient inflow ("policy scenario") lowers the costs per life-year gained: G 172,000 (costs per QALY gained: G 144,000). The supply of more donor lungs could reduce the costs per life-year gained to G 159,000 (G 135,000 per QALY gained; G1 =US $0.6, based on exchange rate at the time of the study).
  
  
  CONCLUSIONS
  Lung transplantation is an expensive but effective intervention: survival and quality of life improve substantially after transplantation. The costs per life-year gained are relatively high, compared with other interventions and other types of transplantation. Restricting the patient inflow and/or raising donor supply improves cost-effectiveness to some degree. Limiting the extent of inpatient screening or lower future costs of immunosuppressives may slightly improve the cost-effectiveness of the program.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Al
authors.forename: M A
authors.initials: MA
authors.lastname: Koopmanschap
authors.forename: P J
authors.initials: PJ
authors.lastname: van Enckevort
authors.forename: A
authors.initials: A
authors.lastname: Geertsma
authors.forename: W
authors.initials: W
authors.lastname: van der Bij
authors.forename: W J
authors.initials: WJ
authors.lastname: de Boer
authors.forename: E M
authors.initials: EM
authors.lastname: TenVergert
mesh_terms: D003362:Cost-Benefit Analysis / Q000639:trends; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D016040:Lung Transplantation / Q000191:economics* / Q000401:mortality / Q000523:psychology; D009426:Netherlands; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014019:Tissue Donors