An Economic Evaluation of Pediatric Small Bowel Transplantation in the United Kingdom

Abstract

Firm conclusions on cost-effectiveness of SBTx are not possible given the two different estimates. The prognostic model approach (suggesting that pediatric SBTx may provide a small survival benefit at a small reduction in costs) should be less subject to bias, but the model requires external validation. Meanwhile, children at risk of fatal PN-complications should be given the opportunity to receive a SBTx only within a continuing formal assessment of the technology.

Interdisciplinary management of infantile short bowel syndrome: resource consumption, growth, and nutrition

“…In the 1989 study of Caniano and coworkers [8], the average cost of the initial hospitalization was $315,000-equivalent to €389,000 in 2006-with an average stay of 450 days in 10 patients. Recently, Longworth et al [27] showed that the average costs of 24 stable SBS patients (not requiring transplantation) were £159,000 based on 1998/1999 prices-equivalent to €266,000 in 2006-for 30 months, with a mean (SD) hospital stay of 50 (74) days. Finally, Spencer et al [28] calculated the treatment costs during the first 5 years after onset of SBS, including hospital care, outpatient care, and home care.…”

Regionally acquired intestinal failure data suggest an underestimate in national service requirements

“…The cost-effectiveness of CSBLT versus long-term HPN is not clear,38 and is a somewhat artificial argument in light of donor organ shortage for the paediatric population. Local factors (high incidence of NEC) may contribute to our high use of HPN.…”

Update on intestinal rehabilitation after intestinal transplantation

“…A systematic study with a larger patient population (more than 100) is needed. Using a prognostic scoring system to identify costs, which would have been incurred by patients who were not transplanted, a review in the UK in 2006 concluded that small bowel transplantation in children was cost-effective (but with wide confidence intervals) [23]. Data about long-term cost-effectiveness from published data in the United States [11 ] suggest that ITx is a cost-effective alternative to parenteral nutrition -see summary in Table 2.…”