Orthotopic liver transplantation in The Netherlands. The results and impact of a medical technology assessment.
In 1985 Dutch health care authorities and health insurance companies initiated a large-scale technology assessment (TA) of liver transplantation (LTx) in The Netherlands. The 10-year experience of the existing programme in the University Hospital Groningen was investigated. Topics included were patient flow, selection policies, survival, quality-of-life, costs, need, supply of donor organs and organisational aspects. Estimation of the consequences of a non-transplantation scenario allowed for the execution of a cost-effectiveness analysis. Results showed clear improvement by LTx of survival and quality-of-life, though to a lesser degree than expected. Costs of the first transplantation year amounted to Dfl 180,000 (approx US $90,000). The cost-effectiveness ratio ranged from Dfl 47,000 to Dfl 133,000 per life year gained. No overt imbalance between need and donor supply existed or was expected in the near future. The impact of this study is related to the informational value and to the contribution to the decision-process. Even at its appearance in 1988, the final report provided health policy makers with new information. Health policy concerning LTx was considerably influenced, as a rule in agreement with the study conclusions. We conclude the Dutch case study to be an example of a useful and efficient TA.
Bonsel
G J
GJ
Department of Public Health and Social Medicine, Erasmus University, Rotterdam, The Netherlands.
Essink-Bot
M L
ML
de Charro
F T
FT
van der Maas
P J
PJ
Habbema
J D
JD
D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003657:Decision Making; D006291:Health Policy; D006785:Hospitals, University / Q000706:statistics & numerical data*; D015993:Life Tables; D016031:Liver Transplantation / Q000191:economics; D009426:Netherlands; D011788:Quality of Life; D012107:Research Design; D016019:Survival Analysis; D013673:Technology Assessment, Biomedical; D014019:Tissue Donors / Q000600:supply & distribution; D014184:Transplantation, Homologous