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Cost-effectiveness of Lung Transplantation in the Netherlands : A Scenario Analysis

Maiwenn J. Al; Marc A. Koopmanschap; Petra J. van Enckevort; Albert Geertsma; Els M. TenVergert; Wim van der Bij; Wim J. de Boer
Author and Funding Information

Affiliations: From the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands,  From the Office for Medical Technology Assessment, University Hospital Groningen, the Netherlands,  From the Department of Pulmonary Diseases, University Hospital Groningen, the Netherlands,  From the Department of Cardiothoracic Surgery, University Hospital Groningen, the Netherlands

Affiliations: From the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands,  From the Office for Medical Technology Assessment, University Hospital Groningen, the Netherlands,  From the Department of Pulmonary Diseases, University Hospital Groningen, the Netherlands,  From the Department of Cardiothoracic Surgery, University Hospital Groningen, the Netherlands

Affiliations: From the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands,  From the Office for Medical Technology Assessment, University Hospital Groningen, the Netherlands,  From the Department of Pulmonary Diseases, University Hospital Groningen, the Netherlands,  From the Department of Cardiothoracic Surgery, University Hospital Groningen, the Netherlands

Affiliations: From the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, the Netherlands,  From the Office for Medical Technology Assessment, University Hospital Groningen, the Netherlands,  From the Department of Pulmonary Diseases, University Hospital Groningen, the Netherlands,  From the Department of Cardiothoracic Surgery, University Hospital Groningen, the Netherlands


1998 by the American College of Chest Physicians


Chest. 1998;113(1):124-130. doi:10.1378/chest.113.1.124
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Abstract

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.


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