Same quality - higher price? The paradox of allocation: the first national single center analysis after the implementation of the new Swiss transplantation law: the ICU view.
This study was undertaken as the first national single-center analysis to assess the impact of the new Swiss transplantation law on patient selection, intensive care unit (ICU) complications, outcome, and, in particular, costs in liver transplant recipients treated in our surgical ICU. The first 35 consecutive liver transplant recipients following the new act were compared with the last 35 liver transplant recipients preceding July 1, 2007. Following execution of the new law, recipients were in poorer condition, reflected by significant higher Model for End-Stage Liver Disease (MELD) scores (12 vs. 22; p = 0.006). Furthermore, the MELD group obtained more renal replacement therapies (40.0% vs. 14.3%; p = 0.015). Cumulative one-yr patient survival was comparable in both groups (91.4% vs. 80.1%, p = 0.22). Finally, the additional costs per single case increased 27 000 Euros after the adoption of the new law. Our data serve as an example that political decisions influence patient's selection, and, in turn, complications, finally leading to higher costs of medical treatment. Liver graft allocation according to the MELD system may save lives at the price of increased intensive care efforts.
Surgical Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Christian E
CE
Oberkofler
Reto
R
Stocker
Dimitri A
DA
Raptis
John F
JF
Stover
Reto A
RA
Schuepbach
Beat
B
Müllhaupt
Philipp
P
Dutkowski
Pierre-Alain
PA
Clavien
Markus
M
Béchir
D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation / Q000191:economics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D013557:Switzerland; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence*