Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, Dr Patrick Northup and colleagues from Virginia, USA performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation.
A multistage Markov decision analysis model was developed with treatment, including medical management only as the first strategy.
Waiting list with possible deceased donor liver transplantation was included in the model as a second strategy.
Waiting list with possible living donor liver transplantation or deceased donor liver transplantation over 10 years was included as a third strategy.
|Living donor liver transplantation offered 5-quality-adjusted life years survival|
|Liver Transplantation |
The team found that decompensated cirrhosis with medical management offered survival of 2 quality-adjusted life years, while costing an average of $65,068.
Waiting list with possible deceased donor liver transplantation offered 4.4-quality-adjusted life years survival and a mean cost of $151,613.
Waiting list with living donor liver transplantation offered 5-quality-adjusted life years survival, and a mean cost of $208,149.
The researchers found that second strategy had an incremental cost-effectiveness ratio of $35,976 over the first strategy.
However, the team noted that the third strategy produced an incremental cost-effectiveness ratio of $106,788 over the second strategy.
On average, the third strategy cost $47,693 more per quality-adjusted life years than the first strategy.
Dr Northup’s team concluded, “Both deceased donor liver transplantation and living donor liver transplantation were cost-effective compared to medical management of cirrhosis over our 10-year study period.”
“The addition of living donor liver transplantation to a standard waiting list deceased donor liver transplantation program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost.”