Cost-effectiveness of lung transplantation in The Netherlands: a scenario analysis.
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.
Al
M J
MJ
Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Koopmanschap
M A
MA
van Enckevort
P J
PJ
Geertsma
A
A
van der Bij
W
W
de Boer
W J
WJ
TenVergert
E M
EM
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