Cost of a Quality-Adjusted Life Year in Liver Transplantation: The Influence of the Indication and the Model for End-Stage Liver Disease Score

Cost issues in liver transplantation (LT) have received increasing attention, but the cost-utility is rarely calculated. We compared costs per quality-adjusted life year (QALY) from the time of placement on the LT waiting list to 1 year after transplantation for 252 LT patients and to 5 years after transplantation for 81 patients. We performed separate calculations for chronic liver disease (CLD), acute liver failure (ALF), and different Model for End-Stage Liver Disease (MELD) scores. For the estimation of QALYs, the health-related quality of life was measured with the 15D instrument. The median costs and QALYs after LT were (SIC)141,768 and 0.895 for 1 year and (SIC)177,618 and 3.960 for 5 years, respectively. The costs of the first year were 80% of the 5-year costs. The main cost during years 2 to 5 was immunosuppression drugs (59% of the annual costs). The cost/QALY ratio improved from (SIC)158,400/QALY at 1 year to (SIC)44,854/QALY at 5 years, and the ratio was more beneficial for CLD patients ((SIC)42,500/QALY) versus ALF patients ((SIC)63,957/QALY) and for patients with low MELD scores versus patients with high MELD scores. Although patients with CLD and MELD scores > 25 demonstrated markedly higher 5-year costs ((SIC)228,434) than patients with MELD scores < 15 ((SIC)169,541), the cost/QALY difference was less pronounced ((SIC)59,894/QALY and (SIC)41,769/QALY, respectively). The cost/QALY ratio for LT appears favorable, but it is dependent on the assessed time period and the severity of the liver disease. Liver Transpl 17:1333-1343, 2011. (C) 2011 AASLD.