Article type
Year
Abstract
Introduction/Objective: To assess the cost-effectiveness of the Dutch lung transplantation (Lgtx) programme in order to support reimbursement decisions and organisational decisions (e.g. number of transplant centres) regarding Lgtx in the Netherlands.
Methods: Costs and effects in the situation with and without a Lgtx programme were compared. In view of the expected positive effects of Lgtx, it was considered ethically inadmissible to perform a randomized clinical trial. Therefore, all patients were admitted to the Lgtx programme and no control group was available. Costs and effects were registered for all patients in the Lgtx programme, and in all phases of the programme (screening: n=303, transplantation: n=57). As no control group was available, costs and effects in the situation without the programme were based on pre-transplantation data of the patients in the programme. Both incremental costs per life year and per Quality Adjusted Life Year (QALY) gained were assessed. Utility scores were based on the EuroQol.
Results: Lifetime incremental costs of the Lgtx programme were estimated at US$ 315,000 per transplanted patient, of which 65% incurred during the outpatient follow-up. The number of life years and QALYs gained were 4.37 and 5.20, respectively. Costs per life year and per QALY gained were US$ 90,000 and US$ 71,000 (discounted at 5%), respectively.
Discussion: Lgtx is a costly intervention that improves survival and quality of life. Compared to the cost-effectiveness of liver- and heart transplantation in the Netherlands, the cost-effectiveness of Lgtx is unfavourable. At this moment no decisions regarding Lgtx are made by the Dutch government. However, recently, the Dutch National Health Insurance Board advised the minister of Health Affairs for the moment not to include Lgtx in the benefit package. Moreover, they advised to proceed the Lgtx programme (subsidized by a development grant) in a limited number of centres, and to investigate the possibility of decreasing the costs and improving the cost-effectiveness of Lgtx.
Methods: Costs and effects in the situation with and without a Lgtx programme were compared. In view of the expected positive effects of Lgtx, it was considered ethically inadmissible to perform a randomized clinical trial. Therefore, all patients were admitted to the Lgtx programme and no control group was available. Costs and effects were registered for all patients in the Lgtx programme, and in all phases of the programme (screening: n=303, transplantation: n=57). As no control group was available, costs and effects in the situation without the programme were based on pre-transplantation data of the patients in the programme. Both incremental costs per life year and per Quality Adjusted Life Year (QALY) gained were assessed. Utility scores were based on the EuroQol.
Results: Lifetime incremental costs of the Lgtx programme were estimated at US$ 315,000 per transplanted patient, of which 65% incurred during the outpatient follow-up. The number of life years and QALYs gained were 4.37 and 5.20, respectively. Costs per life year and per QALY gained were US$ 90,000 and US$ 71,000 (discounted at 5%), respectively.
Discussion: Lgtx is a costly intervention that improves survival and quality of life. Compared to the cost-effectiveness of liver- and heart transplantation in the Netherlands, the cost-effectiveness of Lgtx is unfavourable. At this moment no decisions regarding Lgtx are made by the Dutch government. However, recently, the Dutch National Health Insurance Board advised the minister of Health Affairs for the moment not to include Lgtx in the benefit package. Moreover, they advised to proceed the Lgtx programme (subsidized by a development grant) in a limited number of centres, and to investigate the possibility of decreasing the costs and improving the cost-effectiveness of Lgtx.