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J Thorac Cardiovasc Surg 2002;123:411-420
© 2002 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

An economic evaluation of lung transplantation

Ani C. Anyanwu, MSc, MD, FRCS, Alistair McGuire, PhD, Chris A. Rogers, PhD, A. J. Murday, MA, MS, FRCS

From the Department of Economics, City University, London and the UK Cardiothoracic Transplant Audit, Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom.

Funded by the Department of Health.

Received for publication May 14, 2001; revisions requested June 22, 2001; revisions received July 13, 2001; accepted for publication July 23, 2001. Address for reprints: A. J. Murday, MA, MS, FRCS, Director of Intrathoracic Transplantation, Scottish Cardiopulmonary Transplant Unit, Glasgow Royal Infirmary, Alexander Parade, Glasgow G31 2ER, United Kingdom (E-mail: andrew.murday{at}btinternet.com).

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.


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