Cost-effectiveness of lung transplantation in relation to type of end-stage pulmonary disease.
The purpose of this study was to explore the relationship between diagnosis and the cost-effectiveness and cost-utility of lung transplantation. A microsimulation model was used, based on empirical data from the Dutch lung transplantation program, collected between 1991 and 1999. We assessed life-years, quality-adjusted life-years, and costs with and without transplantation for the diagnostic categories alfa-1 antitrypsin deficiency, COPD/emphysema, bronchiectasis, primary and secondary pulmonary hypertension, cystic fibrosis, and pulmonary fibrosis. Alfa-1 antitrypsin deficiency and bronchiectasis had the highest survival gain. Secondary pulmonary hypertension and pulmonary fibrosis had the lowest survival gain and the lowest gain of quality-adjusted life-years. As compared with COPD/emphysema, alfa-1 antitrypsin deficiency, bronchiectasis, and CF had 25%, 40% and 19% more favorable cost-effectiveness ratios, respectively. Cost-utility ratios varied less, with values of -7%, -14% and -11% for alfa-1 antitrypsin deficiency, bronchiectasis, and primary pulmonary hypertension, respectively, compared with COPD. In conclusion, our model suggests that there is considerable variation in cost-effectiveness and, to a lesser degree, in cost-utility between the different diagnostic categories. These variations are the result of differences in survival and in quality of life with and without lung transplantation.
Groen
H
H
Department of Pulmonology, Groningen University Hospital, Groningen, the Netherlands. h.groen@mta.azg.nl
van der Bij
W
W
Koëter
G H
GH
TenVergert
E M
EM
D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003550:Cystic Fibrosis / Q000628:therapy; D006085:Graft Survival; D006801:Humans; D006976:Hypertension, Pulmonary / Q000473:pathology; D008171:Lung Diseases / Q000628:therapy*; D016040:Lung Transplantation / Q000191:economics* / Q000379:methods*; D011656:Pulmonary Emphysema / Q000628:therapy; D011658:Pulmonary Fibrosis; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome; D019896:alpha 1-Antitrypsin Deficiency / Q000378:metabolism