title: The price of donation after cardiac death in liver transplantation: a prospective cost-effectiveness study.
abstract: This study aims to perform a detailed prospective observational multicenter cost-effectiveness study by comparing liver transplantations with donation after brain death (DBD) and donation after cardiac death (DCD) grafts. All liver transplantations in the three Dutch liver transplant centers between 2004 and 2009 were included with 1-year follow-up. Primary outcome parameter was cost per life year after transplantation. Secondary outcome parameters were 1-year patient and graft survival, complications, and patient-level costs. From 382 recipients that underwent 423 liver transplantations, 293 were primarily transplanted with DBD and 89 with DCD organs. Baseline characteristics were not different between both groups. The Donor Risk Index was significantly different as were cold and warm ischemic time. Ward stay was significantly longer in DCD transplantations. Patient and graft survival were not significantly different. Patients receiving DCD organs had more and more severe complications. The cost per life year for DBD was € 88,913 compared to € 112,376 for DCD. This difference was statistically significant. DCD livers have more and more severe complications, more reinterventions and consequently higher costs than DBD livers. However, patient and graft survival was not different in this study. Reimbursement should be differentiated to better accommodate DCD transplantations.
authors: Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. c.s.van.der.hilst@umcg.nl
authors: Christian S
authors: CS
authors: van der Hilst
authors: Alexander J C
authors: AJ
authors: Ijtsma
authors: Jan T
authors: JT
authors: Bottema
authors: Bart
authors: B
authors: van Hoek
authors: Jeroen
authors: J
authors: Dubbeld
authors: Herold J
authors: HJ
authors: Metselaar
authors: Geert
authors: G
authors: Kazemier
authors: Aad P
authors: AP
authors: van den Berg
authors: Robert J
authors: RJ
authors: Porte
authors: Maarten J H
authors: MJ
authors: Slooff
mesh_terms: D003362:Cost-Benefit Analysis; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D009927:Tissue and Organ Procurement / Q000191:economics*