Cost-effectiveness of lung transplantation and its evolution: the Portuguese case

We analyzed the costs and outcomes of lung transplant in Portugal and its evolution since it was first performed in 2000.

Data were collected for all patients waiting for transplant from 31 December 2000 until 31 December 2010 (n = 61). Patients waiting for transplant were used as the comparison group. We calculated the mean restricted survival time using the Kaplan-Meier estimation method. The time horizon was closed upon the death of the last surviving patient. Costs and consequences were discounted at 5% per annum. We calculated the incremental cost-effectiveness ratio of transplant as compared to no transplant. Deterministic and probabilistic sensitivity analyses were performed. We tested volume-outcome effects using a parametric survival regression.

The cost of lung transplantation was 77,223€ per QALY and 121,276€ per life-year. Assuming a 50,000€/QALY willingness-to-pay, lung transplant would be cost-effective with a 37% probability. Survival improved substantially from 5.15 years over the 2001-2010 period to 6.94 years for the 2008-2010 period. When restricting our analysis to the 2008-2010 period, the cost-effectiveness ratio decreased to €79,016 per life-year gained and €69,241 per QALY. Survival was significantly associated with the number of procedures performed.

Although above commonly accepted cost-effectiveness thresholds, the economic value of lung transplant holds promise in Portugal due to the large improvement in survival over the 2001-2010 period. The life-threatening character of the motivating conditions, the absence of alternative treatment, and equity concerns should be also accounted for when assessing the "value for money" of lung transplant.