title: Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost.
abstract: Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality-adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4-QALY survival and a mean cost of $151,613, and waiting list with possible DDLT or LDLT offered 4.9-QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost-effectiveness ratio (ICER) of $35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost-effective compared to medical management of cirrhosis over our 10-year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost.
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, VA, USA. patrick_northup@virginia.edu
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
authors.forename: Jean C
authors.initials: JC
authors.lastname: Emond
authors.forename: Vanessa D
authors.initials: VD
authors.lastname: Lee
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Lan
authors.initials: L
authors.lastname: Tong
authors.forename: Carl L
authors.initials: CL
authors.lastname: Berg
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D014850:Waiting Lists