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Published on: September 21, 2021
Cost-effectiveness of pediatric heart transplantation
Jeffrey D Dayton1, Kirk R Kanter, Robert N Vincent
1Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322-1062, USA.
Insights
Pediatric heart transplantation is cost-effective, with primary transplants offering good value. Re-transplantation is more expensive due to shorter graft survival, making it less cost-effective.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Health Economics
Background:
- Pediatric heart transplantation survival rates are improving.
- Graft survival averages less than 15 years, with substantial associated costs.
- The study evaluates the cost-effectiveness of pediatric heart transplantation.
Purpose of the Study:
- To determine the cost-effectiveness of pediatric heart transplantation.
- To analyze costs associated with primary versus re-transplantation.
- To compare costs per quality-adjusted life-years (QALYs) gained.
Main Methods:
- Reviewed data from 95 pediatric subjects (1997-2004).
- Calculated costs including pre-transplant care, organ procurement, hospitalization, and follow-up.
- Derived life expectancy from UNOS data; discounted QALYs at 3%.
Main Results:
- Primary transplant costs: $221,897 (initial), $18,480/year (follow-up).
- Re-transplant costs: $285,296 (initial), $18,480/year (follow-up).
- Cost per QALY gained: $49,679 (primary), $87,883 (re-transplant).
Conclusions:
- Primary pediatric heart transplantation falls within acceptable cost-effectiveness ranges.
- Pediatric heart re-transplantation presents higher costs relative to benefits.
- Shorter graft survival impacts the cost-effectiveness of re-transplantation.
Background:
Survival after pediatric heart transplantation has continued to improve. Nonetheless, graft survival is generally <15 years and the costs of transplantation and subsequent immunosuppression are substantial. In the present study, we sought to examine the cost-effectiveness of pediatric heart transplantation.
Methods:
Data from 95 pediatric subjects undergoing transplantation at our institution from 1997 through 2004 were reviewed to determine the costs of pediatric heart transplantation. Costs included pre-transplant care, organ procurement, initial hospitalization and follow-up care. Life expectancy was derived from the United Network of Organ Sharing data set. Data were reported as cost per quality-adjusted life-years (QALYs) gained, which were discounted at 3%. Cost-effectiveness was stratified by primary transplantation vs re-transplantation.
Results:
The mean cost of initial hospitalization and organ procurement was $221,897 per patient for primary transplant and $285,296 per patient for re-transplant. Annual follow-up costs were estimated to be $18,141 in the first year (excluding the first 90 days post-transplant) and $18,480 per year thereafter. Under base-case assumptions, costs per QALY gained were $49,679 for primary transplantation and $87,883 for re-transplantation. Sensitivity analysis yielded a cost-utility range of $44,943 to $57,628 per QALY gained for primary transplantation and $70,834 to $103,661 per QALY gained for re-transplantation.
Conclusions:
Costs of primary pediatric heart transplantation are within the accepted range of cost effectiveness. Pediatric heart re-transplantation has higher costs relative to benefits gained owing to shorter graft survival.
