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Updated: Feb 11, 2026
Method of Isolated Ex Vivo Lung Perfusion in a Rat Model: Lessons Learned from Developing a Rat EVLP Program
Published on: February 25, 2015
Economic evaluation of ex-vivo lung perfusion for lung transplantation: A cost-utility analysis from a large Canadian
John K Peel1, David M J Naimark2, Eleanor M Pullenayegum3
1Department of Anesthesiology, University Health Network, University of Toronto, Toronto, ON, Canada; Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School for Public Health, University of Toronto, Toronto, ON, Canada.
Background:
Ex-vivo lung perfusion (EVLP) enables evaluation and rehabilitation of potentially-useable donor lungs outside the body prior to transplantation. However, its health economic implications are unclear. We sought to determine the cost-utility of adding EVLP to the Toronto Lung Transplant Program.
Methods:
We performed a cost-utility analysis, from the hospital perspective, using an individual-level simulation with a lifetime time horizon. We considered adults with end-stage lung disease waitlisted for first lung transplantation in Ontario, Canada from 2005 to 2019. We compared a situation in which all donor lungs were conventionally preserved (No-EVLP) versus a situation with conventionally-preserved lungs plus EVLP-treated qualifying donor lungs (EVLP available). We estimated lifetime costs (2019 CAD), health outcomes, and quality-adjusted life years (QALYs), discounted at 1.5% annually; results were summarized as incremental net monetary benefit (iNMB).
Results:
EVLP-availability yielded shorter waitlist duration (101 [95% credible interval CI 79-125] days versus 258 [95% CI 222-294] days; p<0.001) and reduced waitlist mortality (9.1% [95%CI 7.3-11%] versus 19.3% [95%CI 17.1-21.8%]; p<0.001). Having EVLP available resulted in lower cumulative costs ($273,827 [95%CI $248,190-$299,654] versus $308,790 [95%CI $271,836-$342,431]; p<0.001), with higher QALY (4.72 [95%CI 3.75-5.26] QALY versus 4 [95%CI 3.07-4.59] QALY; p<0.001). At a cost-effectiveness threshold of $50,000 per QALY, we estimated an iNMB of $70,987 (95%CI $57,721-$76,414); EVLP was considered cost-effective at all thresholds evaluated between $0 and $100,000 per QALY.
Conclusions:
The benefits of having EVLP available at our center outweighed its costs; investment in EVLP is economically justifiable.
Twitter / X Post:
In economic evaluation, the benefits of having ex-vivo lung perfusion for lung transplantation outweighed its costs. EVLP was cost-effective at all thresholds, with higher QALYs and lower cumulative costs.
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