[Liver transplantation for chronic liver disease: hospital costs]

Alcoholic cirrhosis and viral (especially hepatitis C) cirrhosis account for 50% of liver transplantation indications. The aim of our study was to evaluate the cost of liver transplantation from the hospital's perspective, according to indication.

This retrospective study at a university hospital included 60 patients (cause of liver disease: alcoholic or hepatitis C-induced cirrhosis) who underwent liver transplantation between 1996 and 1999. All patients received the liver of brain-dead donors. The outcome measure was the cost of hospitalization from admission for transplantation through two years afterwards. The study does not include the costs of pre-transplantation evaluation or organ procurement. To calculate medical costs, we collected data about pharmaceutical use and laboratory tests for each patient. Logistic costs were calculated from French data for diagnosis-related groups, according to length of stay. Consultations and admissions in the two years after transplantation were collected, and their costs calculated.

Length of stay for transplantation (mean: 24 days, range 11-66) and costs (average 40 keuro per patient, range: 27.8-75.7, i.e., 52 keuro after escalation to 2006 levels) were similar. The cost of transplantation was higher (p=0.002) for Child C patients (mean: 46 keuro per patient, range: 31,1-72,8). Costs of follow-up after transplant (mean 5.4 keuro per patient, range: 0.87-19.7) varied, with consultation costs higher (p=0.002) in the alcoholic cirrhosis group (0.38 keuro versus 0.3 keuro) and hospitalization more expensive (p=0.0496) for the viral cirrhosis group (6 keuro versus 4,6 keuro).

We found that length of stay was the most important determinant of hospital costs for liver transplantation and that the indication for transplantation has a slight influence on resource utilization during the first two years after surgery.