Cost-effectiveness of cadaveric and living-donor liver transplantation.
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 (E 22,451 and E 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.
Sagmeister
Markus
M
Division of Gastroenterology and Hepatology, University Hospital, 8091 Zürich, Switzerland. markus.sagmeister@dim.usz.ch
Mullhaupt
Beat
B
Kadry
Zakiyah
Z
Kullak-Ublick
Gerd A
GA
Clavien
Pierre A
PA
Renner
Eberhard L
EL
D000328:Adult; D000368:Aged; D002102:Cadaver; D003362:Cost-Benefit Analysis; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000191:economics* / Q000401:mortality / Q000502:physiology; D019520:Living Donors; D008875:Middle Aged; D015996:Survival Rate; D013557:Switzerland; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics*