Cost-effectiveness of pediatric heart transplantation.
BACKGROUND
Survival after pediatric heart transplantation has continued to improve. Nonetheless, graft survival is generally <15 years and the costs of transplantation and subsequent immunosuppression are substantial. In the present study, we sought to examine the cost-effectiveness of pediatric heart transplantation.


METHODS
Data from 95 pediatric subjects undergoing transplantation at our institution from 1997 through 2004 were reviewed to determine the costs of pediatric heart transplantation. Costs included pre-transplant care, organ procurement, initial hospitalization and follow-up care. Life expectancy was derived from the United Network of Organ Sharing data set. Data were reported as cost per quality-adjusted life-years (QALYs) gained, which were discounted at 3%. Cost-effectiveness was stratified by primary transplantation vs re-transplantation.


RESULTS
The mean cost of initial hospitalization and organ procurement was $221,897 per patient for primary transplant and $285,296 per patient for re-transplant. Annual follow-up costs were estimated to be $18,141 in the first year (excluding the first 90 days post-transplant) and $18,480 per year thereafter. Under base-case assumptions, costs per QALY gained were $49,679 for primary transplantation and $87,883 for re-transplantation. Sensitivity analysis yielded a cost-utility range of $44,943 to $57,628 per QALY gained for primary transplantation and $70,834 to $103,661 per QALY gained for re-transplantation.


CONCLUSIONS
Costs of primary pediatric heart transplantation are within the accepted range of cost effectiveness. Pediatric heart re-transplantation has higher costs relative to benefits gained owing to shorter graft survival.
Dayton
Jeffrey D
JD
Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322-1062, USA.
Kanter
Kirk R
KR
Vincent
Robert N
RN
Mahle
William T
WT
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy; D011788:Quality of Life