title: Cost of a quality-adjusted life year in liver transplantation: the influence of the indication and the model for end-stage liver disease score.
abstract: Cost issues in liver transplantation (LT) have received increasing attention, but the cost-utility is rarely calculated. We compared costs per quality-adjusted life year (QALY) from the time of placement on the LT waiting list to 1 year after transplantation for 252 LT patients and to 5 years after transplantation for 81 patients. We performed separate calculations for chronic liver disease (CLD), acute liver failure (ALF), and different Model for End-Stage Liver Disease (MELD) scores. For the estimation of QALYs, the health-related quality of life was measured with the 15D instrument. The median costs and QALYs after LT were €141,768 and 0.895 for 1 year and €177,618 and 3.960 for 5 years, respectively. The costs of the first year were 80% of the 5-year costs. The main cost during years 2 to 5 was immunosuppression drugs (59% of the annual costs). The cost/QALY ratio improved from €158,400/QALY at 1 year to €44,854/QALY at 5 years, and the ratio was more beneficial for CLD patients (€42,500/QALY) versus ALF patients (€63,957/QALY) and for patients with low MELD scores versus patients with high MELD scores. Although patients with CLD and MELD scores > 25 demonstrated markedly higher 5-year costs (€228,434) than patients with MELD scores < 15 (€169,541), the cost/QALY difference was less pronounced (€59,894/QALY and €41,769/QALY, respectively). The cost/QALY ratio for LT appears favorable, but it is dependent on the assessed time period and the severity of the liver disease.
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland. fredrik.aberg@helsinki.fi
authors.forename: Fredrik
authors.initials: F
authors.lastname: Åberg
authors.forename: Suvi
authors.initials: S
authors.lastname: Mäklin
authors.forename: Pirjo
authors.initials: P
authors.lastname: Räsänen
authors.forename: Risto P
authors.initials: RP
authors.lastname: Roine
authors.forename: Harri
authors.initials: H
authors.lastname: Sintonen
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Koivusalo
authors.forename: Krister
authors.initials: K
authors.lastname: Höckerstedt
authors.forename: Helena
authors.initials: H
authors.lastname: Isoniemi
mesh_terms: D000328:Adult; D015209:Cholangitis, Sclerosing / Q000191:economics / Q000401:mortality / Q000601:surgery; D003362:Cost-Benefit Analysis / Q000191:economics / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics; D008105:Liver Cirrhosis, Biliary / Q000191:economics / Q000401:mortality / Q000601:surgery; D008108:Liver Diseases, Alcoholic / Q000191:economics / Q000401:mortality / Q000601:surgery; D017093:Liver Failure / Q000191:economics / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
chemical_list: D007166:Immunosuppressive Agents