title: Cost-effectiveness of lung transplantation and its evolution: the Portuguese case.
abstract: OBJECTIVE
  We analyzed the costs and outcomes of lung transplant in Portugal and its evolution since it was first performed in 2000.
  
  
  METHODS
  Data were collected for all patients waiting for transplant from 31 December 2000 until 31 December 2010 (n = 61). Patients waiting for transplant were used as the comparison group. We calculated the mean restricted survival time using the Kaplan-Meier estimation method. The time horizon was closed upon the death of the last surviving patient. Costs and consequences were discounted at 5% per annum. We calculated the incremental cost-effectiveness ratio of transplant as compared to no transplant. Deterministic and probabilistic sensitivity analyses were performed. We tested volume-outcome effects using a parametric survival regression.
  
  
  RESULTS
  The cost of lung transplantation was 77,223€ per QALY and 121,276€ per life-year. Assuming a 50,000€/QALY willingness-to-pay, lung transplant would be cost-effective with a 37% probability. Survival improved substantially from 5.15 years over the 2001-2010 period to 6.94 years for the 2008-2010 period. When restricting our analysis to the 2008-2010 period, the cost-effectiveness ratio decreased to €79,016 per life-year gained and €69,241 per QALY. Survival was significantly associated with the number of procedures performed.
  
  
  CONCLUSIONS
  Although above commonly accepted cost-effectiveness thresholds, the economic value of lung transplant holds promise in Portugal due to the large improvement in survival over the 2001-2010 period. The life-threatening character of the motivating conditions, the absence of alternative treatment, and equity concerns should be also accounted for when assessing the "value for money" of lung transplant.
authors.affiliation: Hospital das Forças Armadas, Lisbon, Portugal, luis.manuel.mendonca@gmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Mendonça
authors.forename: Julian
authors.initials: J
authors.lastname: Perelman
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rodrigues
authors.forename: José
authors.initials: J
authors.lastname: Fragata
mesh_terms: D000367:Age Factors; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D011174:Portugal / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D014850:Waiting Lists
references.citation: Thorax. 2001 Mar;56(3):218-22
references.pmid: 11182015
references.citation: Health Technol Assess. 2009 Jun;13(29):iii, ix-xi, 1-61
references.pmid: 19500484
references.citation: Eur Respir J. 2003 Nov;22(5):845-52
references.pmid: 14621095
references.citation: J Thorac Cardiovasc Surg. 2002 Mar;123(3):411-8; discussion 418-20
references.pmid: 11882810
references.citation: Health Econ. 2002 Apr;11(3):233-48
references.pmid: 11921320
references.citation: J Heart Lung Transplant. 2005 Sep;24(9):1275-83
references.pmid: 16143245
references.citation: Am J Transplant. 2004 Jul;4(7):1155-62
references.pmid: 15196075
references.citation: J Heart Lung Transplant. 2012 Oct;31(10):1073-86
references.pmid: 22975097
references.citation: Ann Intern Med. 2002 Sep 17;137(6):511-20
references.pmid: 12230353