Cost of a quality-adjusted life year in liver... : Liver Transplantation (original) (raw)

Original Articles

Cost of a quality-adjusted life year in liver transplantation: The influence of the indication and the model for end-stage liver disease score

Åberg, Fredrik1; Mäklin, Suvi3; Räsänen, Pirjo3,4; Roine, Risto P.4; Sintonen, Harri5; Koivusalo, Anna-Maria2; Höckerstedt, Krister1; Isoniemi, Helena1

1Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland

2Department of Anesthesia and Intensive Care Unit, Helsinki University Hospital, Helsinki, Finland

3Finnish Office for Health Technology Assessment, National Institute for Health and Welfare, Helsinki, Finland

4Group Administration, Hospital District of Helsinki and Uusimaa, Helsinki, Finland

5Hjelt Institute, Department of Public Health, University of Helsinki, Helsinki, Finland

Address reprint requests to Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Post Box 372, Helsinki, Finland 00029

Email: [email protected]

Received 26 April 2011; Accepted 11 July 2011

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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.

Abbreviations: 15D, 15-dimensional; ALF, acute liver failure; CI, confidence interval; CLD, chronic liver disease; HCC, hepatocellular carcinoma; HRQOL, health-related quality of life; LT, liver transplantation; MARS, Molecular Adsorbents Recirculating System; MELD, Model for End-Stage Liver Disease; NS, not significant; PBC, primary biliary cirrhosis; PSC, primary sclerosing cholangitis; QALY, quality-adjusted life year.