A Study on Medico-economical Analysis of Organ Transplant

考虑器官移植的经济问题对建立移植医学具有重要意义。本研究对器官移植尤其是心脏移植进行了成本分析和成本效益分析。首先，设计了以下计算方法作为成本分析（1）计算移植手术和术后管理的成本作为移植的直接成本，（2）计算供体心脏运输的成本和器官移植网络系统的工作成本，如信息系统和人员费用作为移植的间接成本。心脏移植的成本是直接和间接成本的总和。接下来，设计了以下方法作为CBA。(1)移植延长寿命的时间被用作移植有效性的指标。(2)质量调整年（QALY）被用作 ...更多信息 移植效用指数。(3)移植效益的计算是根据质量调整生命年，采用霍夫曼法，这是通常用于交通事故的赔偿。真实的效益是指心脏移植的效益与成本之差。利用上述方法，进行了以下几种情况下的成本效益试算。(1)移植成本（1）直接费用：摘取供心230万，移植手术294万，住院（2个月）3，644，000日元，术后管理（移植后3个月至1年），4，060，000/年（2）间接费用：器官移植网络系统的工作费用120万/例移植;（3）心脏移植费用1537.5万。(2)CBA：（1）效益：88，827，200（如果是男性和50岁有薪男子，工作能力系数为0.8），（2）真实的福利：6，462，200减

It is important to consider economic problems of organ transplant in order to establish transplantation medicine, In the present study, we conducted the problems in which a cost-analysis and a cost-benefit analysis (CBA) of organ transplant, especially heart transplant were included. In the first place, the following calculation method was contrived as the cost-analysis (1) Calculation of costs of operations for transplantation and post-operative management as the direct cost of the transplant, (2) Calculation of costs of donor heart transportation and working costs of a organ transplant network system such as informaton system and personnel expenses as the indirect cost of the transplant. The cost of heart transplant is obtained as the sum of the direct and indirect costs. Next, the following method was contrived as the CBA.(1) The time of prolongation of life by the transplant is adopted as an index of the transplant effectiveness. (2) The quality adjusted years (QALY) is used as an … More index of the transplant utility. (3) The transplant benefit is calculated depending upon QALY by using the Hoffman method which is usually used for compensation of traffic accident. Real benefit is obtained as the difference of the benefit and the cost of the heart transplant. By using the before-mentioned methods, the following trial calculation of the cost and benefit was conducted under several conditions.(1) Transplant cost (normal cases) : (1) Direct costs : extraction of donor heart \ 2,300,000, operations for transplantation \ 2,940,000, admission to a hospital (2 months) \ 3,644,000, post-operative management (3 months - one year after transplantation), \ 4,060,000/year (on and after two years), (2) Indirect costs : transportation of donor heart \ 1,300,000, working costs of the organ transplant network system \ 1,200,000/1 transplant, (3) Cost of heart transplant \ 15,375,000.(2) CBA : (1) Benefit : \ 88,827,200 (in case of a male and 50 years old salaried man under the condition of work ability coefficient : 0.8), (2) Real benefit : \ 6,462,200 Less