Cost-effectiveness of lung transplantation in the Netherlands - A scenario analysis

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.