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Cost-effectiveness of lung transplantation in The Netherlands: a scenario analysis
M J Al1, M A Koopmanschap, P J van Enckevort
1Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
Study Objectives:
To calculate cost-effectiveness of scenarios concerning lung transplantation in The Netherlands.
Design:
Microsimulation model predicting survival, quality of life, and costs with and without transplantation program, based on data of the Dutch lung transplantation program of 1990 to 1995.
Setting:
Netherlands, University Hospital Groningen.
Patients:
Included were 425 patients referred for lung transplantation, of whom 57 underwent transplantation.
Intervention:
Lung transplantation.
Results:
For the baseline scenario, the costs per life-year gained are G 194,000 (G=Netherlands guilders) and the costs per quality-adjusted life-year (QALY) gained are G 167,000. Restricting patient inflow ("policy scenario") lowers the costs per life-year gained: G 172,000 (costs per QALY gained: G 144,000). The supply of more donor lungs could reduce the costs per life-year gained to G 159,000 (G 135,000 per QALY gained; G1 =US $0.6, based on exchange rate at the time of the study).
Conclusions:
Lung transplantation is an expensive but effective intervention: survival and quality of life improve substantially after transplantation. The costs per life-year gained are relatively high, compared with other interventions and other types of transplantation. Restricting the patient inflow and/or raising donor supply improves cost-effectiveness to some degree. Limiting the extent of inpatient screening or lower future costs of immunosuppressives may slightly improve the cost-effectiveness of the program.