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PubMed ID:
19177435
Public Release Type:
Journal
Publication Year: 2009
Affiliation: Department of Medicine, University of Virginia, Charlottesville, VA, USA. patrick_northup@virginia.edu
DOI:
https://doi.org/10.1002/lt.21671
Authors:
Emond JC,
Northup PG,
Abecassis MM,
Englesbe MJ,
Lee VD,
Stukenborg GJ,
Tong L,
Berg CL,
Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group,
Emond JC,
Brown RS Jr,
Odeh-Ramadan R,
Heese S,
Abecassis MM,
Blei A,
Al-Saden P,
Shaked A,
Olthoff KM,
Kaminski M,
Shaw M,
Trotter JF,
Kam I,
Garcia C,
Busuttil RW,
Saab S,
Mooney J,
Freise CE,
Terrault NA,
MacLeod D,
Merion RM,
Lok AS,
Ojo AO,
Gillespie BW,
Hill-Callahan M,
Howell T,
Tong L,
Shearon TH,
Wisniewski KA,
Lowe M,
Hayashi PH,
Nielsen CA,
Berg CL,
Pruett TL,
Davis J,
Fisher RA,
Shiffman ML,
Fenick E,
Ashworth A,
Everhart JE,
Seeff LB,
Robuck PR,
Hoofnagle JH
Studies:
Adult Living Donor Liver Transplantation Studies
Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality-adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4-QALY survival and a mean cost of $151,613, and waiting list with possible DDLT or LDLT offered 4.9-QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost-effectiveness ratio (ICER) of $35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost-effective compared to medical management of cirrhosis over our 10-year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost.
