An economic analysis of heart-lung transplantation

Evans, Roger W.; Manninen, Diane L.; Dong, Frederick B.

doi:10.1016/s0022-5223(19)33768-7

Cited by 12 publications

(2 citation statements)

References 21 publications

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“…Since such figures are not available for pancreas transplantation, they were estimated from other sources. According to the National Cooperative Transplantation study, median charges for the transplant admission alone for KA and SPK were $39 625 and $67 415, respectively [12]. Charges for SPK were 1.7 times higher than those for KA, and SPK costs in this analysis were estimated from KA costs based on this ratio.…”

Section: Methodsmentioning

confidence: 87%

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Cost–utility analysis of living‐donor kidney transplantation followed by pancreas transplantation versus simultaneous pancreas–kidney transplantation

Douzdjian

Escobar

Kupin

et al. 1999

Clinical Transplantation

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For a type I diabetic with end-stage renal disease, the choice between a kidney-alone transplant from a living-donor (KA-LD) and a simultaneous pancreas kidney (SPK) transplant remains a difficult one. The prevailing practice seems to favor KA-LD over SPK, presumably due to the superior long-term renal graft survival in KA-LD and the elimination of the lengthy waiting time on the cadaver transplant list. In this study, two treatment options, KA-LD followed by pancreas-after-kidney (PAK) and SPK transplant, are compared using a cost-utility decision analysis model. The decision tree consisted of a choice between KA-LD + PAK and SPK. The analysis was based on a 5-yr model and the measures of outcome used in the model were cost, utility and cost-utility. The expected 5-yr cost was $277,638 for KA-LD + PAK and $288,466 for SPK. When adjusted for utilities, KA-LD + PAK at a cost of $153,911 was less cost-effective than SPK at a cost of $110,828 per quality-adjusted year. One-way sensitivity analyses were performed by varying patient and graft survival probabilities, utilities and cost. SPK remained the optimal strategy over KA-LD + PAK across all variations. Two-way sensitivity analysis showed that in order for KA-LD + PAK to be at least as cost-effective as SPK, 5-yr pancreas and patient survival rates following PAK would need to surpass 86 and 80%. In conclusion, according to the 5-yr cost-utility model presented in this study, KA-LD followed by PAK is less cost-effective than SPK as a treatment strategy for a type I diabetic with end-stage renal disease. For patients interested in the benefits of a pancreas transplant, it would be reasonable to offer SPK as the optimal treatment, even if a living kidney donor is available.

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Section: Methodsmentioning

confidence: 87%

“…These figures reflect the initial admission only, without first‐year follow‐up. Similarly, the cost for a PAK was estimated based on a PAK/KA ratio of 1:2 derived from previous reports [12,13]. The costs incurred for the management of diabetes were also included in the analysis [14].…”

Section: Methodsmentioning

confidence: 99%