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Publication Information
Affiliation
Department of Medicine, University of Virginia, Charlottesville, VA, USA. patrick_northup@virginia.edu
Authors
Abecassis MM, Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group, Al-Saden P, Ashworth A, Berg CL, Blei A, Brown RS Jr, Busuttil RW, Davis J, Emond JC, Englesbe MJ, Everhart JE, Fenick E, Fisher RA, Freise CE, Garcia C, Gillespie BW, Hayashi PH, Heese S, Hill-Callahan M, Hoofnagle JH, Howell T, Kam I, Kaminski M, Lee VD, Lok AS, Lowe M, MacLeod D, Merion RM, Mooney J, Nielsen CA, Northup PG, Odeh-Ramadan R, Ojo AO, Olthoff KM, Pruett TL, Robuck PR, Saab S, Seeff LB, Shaked A, Shaw M, Shearon TH, Shiffman ML, Stukenborg GJ, Terrault NA, Tong L, Trotter JF, Wisniewski KA
Studies
Citation
Northup PG, Abecassis MM, Englesbe MJ, Emond JC, Lee VD, Stukenborg GJ, Tong L, Berg CL, Adult-to-Adult Living Donor Liver Transplantation Cohort Study Group. Addition of adult-to-adult living donation to liver transplant programs improves survival but at an increased cost. Liver Transpl 2009 Feb;15(2):148-62.Abstract
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.