The Economic Implications of Broader Sharing of Liver Allografts
The Economic Implications of Broader Sharing of Liver Allografts
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DOI：
10.1111/j.1600-6143.2011.03443.x
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发表时间：
2011-04-01
影响因子：
8.8
通讯作者：
Lentine, K. L.
中科院分区：
文献类型：
--
作者：
Axelrod, D. A.;Gheorghian, A.;Lentine, K. L.
在过去的四十年里，肝移植已经发展成为治疗终末期肝衰竭最有效的方法，也是最昂贵的医疗技术之一。准确理解受助人疾病严重程度的财务含义对于评估分配政策的经济影响至关重要。来自器官获取和移植网络的临床数据与来自大学健康系统联盟的成本会计数据相关联的新数据库用于分析15813例肝移植的肝脏移植成本。然后利用这些数据来考虑旨在增加同种异体肝脏移植共享的替代分配系统的经济影响。移植费用与MELD评分评估的受者疾病严重程度密切相关（p < 0.0001）；然而，这种关系并不是线性的。使用双层区域共享方法（MELD 15/25）对低MELD患者肝脏重新分配到高MELD患者的模拟分析结果显示，每年减少88例死亡，估计每节省质量调整生命年的成本为17056美元。结果表明，广泛共享同种异体肝脏移植为降低终末期肝病死亡率提供了一种具有成本效益的策略。
Liver transplantation has evolved over the past four decades into the most effective method to treat end-stage liver failure and one of the most expensive medical technologies available. Accurate understanding of the financial implication of recipient severity of illness is crucial to assessing the economic impact of allocation policies. A novel database of linked clinical data from the Organ Procurement and Transplantation Network with cost accounting data from the University HealthSystem Consortium was used to analyze liver transplant costs for 15 813 liver transplants. This data was then utilized to consider the economic impact of alternative allocation systems designed to increase sharing of liver allografts using simulation results. Transplant costs were strongly associated with recipient severity of illness as assessed by the MELD score (p < 0.0001); however, this relationship was not linear. Simulation analysis of the reallocation of livers from low MELD patients to high MELD using a two-tiered regional sharing approach (MELD 15/25) resulted in 88 fewer deaths annually at estimated cost of $17 056 per quality-adjusted life-year saved. The results suggest that broader sharing of liver allografts offers a cost-effective strategy to reduce the mortality from end stage liver disease.