Cost and outcome analysis and cost determinants of liver transplantation in a European National Health Service Hospital

Background. Liver transplantation has become established therapy for end-stage liver disease. Survival rates are satisfactory and the current challenge is the implementation of cost-optimization policies. Methods. This study was a cost-outcome and cost-determinant analyses in an Italian National Health Services liver transplantation unit. Collection of data related to survival and costs in 235 adult transplant recipients from 1997 to 2000. Costs included consumption-related costs (e.g., diagnostics, medication) and structure-related costs (e.g., staff, general costs, and overhead) allocated individually according to hospital patient days. The main variables were average cost per patient alive at the end of each year, average cost per month of patient alive, and average cost per transplantation. Results. Two hundred fifty-two transplantations were performed in 235 adults (mean follow-up, 16.5 months). Average cost per patient alive was constant (e107,014-e117,782), whereas average cost per month of patient alive progressively diminished to e7,098. Costs differed according to reason for transplantation, being lower in nonviral (mainly alcoholic) hepatitis and higher in fulminant hepatic failure and in rare liver diseases. Higher costs were also observed in patients with portal thrombosis and high pretransplant serum creatinine. The average cost per transplantation was fairly constant (e75,747-e83,846) and plateaued after 120 to 140 transplantations. Conclusions. The optimization of the cost-to-outcome ratio is linked to a reasonably high number of transplants per year, which allows early achievement of a cost-per-transplant plateau associated with a better survival rate, in addition to careful consideration of risk factors and diagnoses.