[Medical and economic evaluation of organ transplantation in France. The example of liver transplantation].
BACKGROUND
Organ transplantation is an expensive and risky medical procedure. Estimating the cost is difficult because the care is complex and involves many actors. We present a methodological framework for the economic evaluation of organ transplantation in France which include a detailed collection of all the direct costs and the simultaneous analysis of health status. It was applied to evaluate the cost of liver transplantation in France.


METHODS
All consecutive adults transplanted or placed on the waiting list of liver transplantation in the Department of Surgery of Cochin Hospital, Paris, between 1994 and 1996 were included. All resource use was measured during one year: staff wages, pharmacy and blood, laboratory and radiology, supplies, overhead hospital services. Mean quality of life was estimated by the survival weighted by the Karnofsky index.


RESULTS
Transplantation: 38 patients were included. The first year mean cost after transplantation was 561,000FF (included rehospitalizations cost of 120,000FF). Care outside the hospital induced 10% of the total cost. Mean quality of life was 63% (from 0% to 93%) and increased with time, whereas cost decreased. Waiting list: 26 of 33 patients on waiting list were transplanted. The first year mean cost was 95,000FF (included 32,000FF for first evaluation) and increased with time. 44% of cost was supported by another hospital than the transplanting one. Sickness allowance added 20% to the cost. The mean quality of life was 56% during the first year.


CONCLUSIONS
This complete approach of organ transplantation cost respected the medical procedure over the time. Detailed costs take into account the care outside the hospital. This method can be used in other countries and generalised to all surgical or medical procedure as heavy as the organ transplantation.
Fourquet
F
F
Département de Biostatistique et d'Informatique Médicale, Hôpital Cochin, 75674 Paris Cedex 14.
Le Galès
C
C
Rufat
P
P
Houssin
D
D
Coste
J
J
D000041:Absenteeism; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality / Q000523:psychology / Q000592:standards*; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects / Q000191:economics* / Q000401:mortality / Q000523:psychology / Q000592:standards*; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists