Costs and outcomes of liver transplantation in adults - A prospective, 1-year, follow-up study

Background. Orthotopic liver transplantation (OLT) is widely used to treat patients with end-stage liver disease. However, data on the cost of the pro cedure are fragmentary. We evaluated the costs, as calculated from resource use, and outcomes of OLT in adults, from registration on the transplant wa iting list to the end of the 1st-year of follow-up after the transplant. Methods. Two parallel cohort studies were conducted from 1994 to 95. All pa tients ages 18 years and older, on the waiting list (n=33) according to nat ional criteria or having undergone transplants (n=38) were followed for 1 y ear or until either the transplant (waiting list cohort) or death (waiting list and transplantation cohorts). Results. Eighty percent of the patients undergoing transplants were alive a fter 1 year, and no patient died while on the waiting list. However, the es timated cost of the procedure was high: more than pound 55,000 for the 1st year after OLT, to be added to pound 5,500 for evaluation and further costs motivated by the planned transplant during an average 6.5 months on the wa iting list. Age over 40 and a baseline Child-Pugh score of 10 and over were predictive of high costs. The proportion of costs associated with immunosu ppressive therapy and rejection were very high. Conclusions. This medical and economic cohort study suggests that OLT is st ill expensive; the study identifies sources of extra cost that could be lim ited either by improved selection of patients or, in the future, by technol ogical advances in immunosuppressive therapy that help avoid medical compli cations. It also suggests the situation is precarious, with outcomes and co sts being very sensitive to variation in graft availability.