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Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups

Longworth, L; Young, T; Buxton, MJ; Ratcliffe, J; Neuberger, J; Burroughs, A; Bryan, S; (2003) Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups. Liver Transplantation , 9 (12) 1295 - 1307. 10.1016/j.lts.2003.09.012.

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Abstract

Liver transplantation has never been the subject of a randomized controlled trial, and there remains uncertainty about the magnitude of benefit and cost-effectiveness for specific patient groups. This article reports the results of an economic evaluation of adult liver transplantation in England and Wales. Patients placed on the waiting list for a liver transplant were observed over 27 months. The costs and health benefits of a comparison group, representing experience in the absence of liver transplantation, were estimated using a combination of observed data from patients waiting for a transplant and published prognostic models. The analysis focuses on three disease groups, for each of which prognostic models were available: primary biliary cirrhrosis (PBC), alcoholic liver disease (ALD), and primary sclerosing cholangitis (PSC). A higher proportion of patients with ALD were assessed for a transplant but not placed on the waiting list. The estimated gain in quality-adjusted life-years from transplantation was positive for each of the disease groups. The mean incremental cost per quality-adjusted life-year (95% bootstrap confidence intervals) from time of listing to 27 months for patients with PBC, ALD, and PSC are £29,000 (£1,000 to £59,000), £48,000 (£12,000 to £83,000) and £21,000 (-£23,000 to £60,000), respectively. In conclusion, liver transplantation increases the survival and health-related quality of life of patients with each of three end-stage liver diseases. However, the extent of this increase differs between different disease groups. Cost-effectiveness estimates were poorer for patients with ALD over the 27-month period than for patients with PBC or PSC. This in part reflects the costs of the higher number of ALD patients assessed for each transplant.

Type:Article
Title:Midterm cost-effectiveness of the liver transplantation program of England and Wales for three disease groups
DOI:10.1016/j.lts.2003.09.012

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