A cost-effectiveness and cost-utility study of lung transplantation

Life-threatening complications and expensive posttransplantation medical care raises the issue whether lung transplantation (L-Tx) is cost effective. We studied, from a health care system perspective, the cost effectiveness (C/E) and cost utility (C/U) of L-Tx in a Canadian setting.

An incremental C/E and C/U analysis of L-Tx, compared with the waiting list (WL), was carried out on 124 patients accepted into the Quebec L-Tx WL (1997-2001). Survival was presented in mean life-years (LYs). Utility, assessed with the standard gamble, was used in computing the quality-adjusted life-years (QALY). Different person-time experiences were simulated. Costs (95% confidence interval), in US dollars, were discounted at 5%.

The mean LYs and QALYs gained were 0.57 (0.36-0.78) and 0.62 (0.36-0.78), respectively. The cost per patient without Tx was 1102 dollars (856 dollars-1348 dollars) per month. The L-Tx program induced a screening cost of 6208 dollars per patient. The cost of the L-Tx procedure (n = 91) was 31,815 dollars (25,301 dollars-44,816 dollars). The post-Tx cost per month in the first, second, third, and fourth year was 1809 dollars dollars (1187 dollars-2446 dollars), 1060 dollars (703 dollars-1478 dollars), 1128 dollars (519 dollars-1735 dollars), and 626 dollars (495 dollars-758 dollars), respectively. The projected C/E and C/U of the L-Tx program, assessed on the basis of pre- and post-Tx extrapolations, reached 40,048 dollars and 46,631 dollars, respectively.

L-Tx in this Canadian setting yielded a benefit in mean LYs and QALYs gained. Although the program is expensive, the C/E and C/U ratios for some patient groups prove to be an acceptable cost for the benefits observed.