Cardiothoracic TransplantationAn economic evaluation of lung transplantation
Cardiothoracic TransplantationAn economic evaluation of lung transplantation
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心胸移植肺移植的经济评价
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
A. Murday
中科院分区：
文献类型：
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作者：
A. Anyanwu;A. Mcguire;C. Rogers;A. Murday
目的：本研究旨在确定在英国，相对于终末期肺病的医学治疗，肺移植获得的每个质量调整生命年的成本。方法：以等待移植的患者为研究对象。通过参数化技术，将4年的国家生存数据外推至15年。质量调整生命年是通过从患者横断面获得的效用评分得出的。资源消耗和费用是根据当地和国家来源计算的。成本和收益按年折现6%。结果：在15年期间，单肺、双肺和心肺移植的平均获益（相对于药物治疗）分别为2.1、3.3和3.6质量调整生命年。同期的平均医疗费用估计为73 564美元，而单肺、双肺和心肺移植分别为176 640美元、180 528美元和178 387美元。单肺移植的每个质量调整生命年的成本为48241美元，双肺移植为32803美元，心肺移植为29285美元。敏感性分析发现成本效益的主要决定因素是移植后的生活质量和维持费用。结论：肺移植可提高生存率和生活质量，但成本仍然昂贵，由于死亡率和发病率高，成本效益有限。肺移植的成本效益可以随着免疫抑制成本的降低和移植后生活质量的提高而提高。
Objective: This study was undertaken to determine the cost per quality-adjusted life-year gained with lung transplantation relative to medical treatment for end-stage lung disease in the United Kingdom. Methods: Patients on the transplant waiting list were used to represent medical treatment. Four-year national survival data were extrapolated to 15 years by means of parametric techniques. Quality-adjusted life-years were derived by means of utility scores obtained from a cross-section of patients. Resource consumption and costs were based on local and national sources. Costs and benefits were discounted at an annual rate of 6%. Results: Across a 15-year period lung transplantation yielded mean benefits (relative to medical treatment) of 2.1, 3.3, and 3.6 quality-adjusted life-years for single-lung, double-lung, and heart-lung transplantation, respectively. During the same period the mean cost of medical treatment was estimated at $73,564, compared with $176,640, $180,528, and $178,387 for single-lung, double-lung, and heart-lung transplantation, respectively. The costs per quality-adjusted life-year gained were $48,241 for single-lung, $32,803 for double-lung, and $29,285 for heart-lung transplantation. Sensitivity analysis found the principal determinants of costeffectiveness to be quality of life and maintenance costs after transplantation. Conclusions: Lung transplantation results in survival and quality of life gains but remains expensive, with cost-effectiveness limited by substantial mortality and morbidity and high costs. The cost-effectiveness of lung transplantation can be improved with lowered immunosuppression costs and improvements in quality of life after transplantation.
J Thorac Cardiovasc Surg 2002;123:411-20