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J Thorac Cardiovasc Surg 2002;123:406-408
© 2002 The American Association for Thoracic Surgery

Editorials

QALYs or quackery? The quagmire of quantifying the cost of breathing

From the Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Received for publication Sept 14, 2001; accepted for publication Sept 27, 2001. Address for reprints: Thomas M. Egan, MD, MSc, Department of Surgery, University of North Carolina at Chapel Hill, 108 Burnett-Womack Building, CB 7065, Chapel Hill, NC 27599-7065.

	Introduction

 
See related article on page 411.

Lung transplantation has become an accepted therapy to palliate end-stage lung disease. Broader application is currently limited by a scarcity of suitable donors. Because it is an expensive undertaking, lung transplantation must be regularly evaluated to ensure that it provides value to society and to the patients who may benefit, because "not even the richest countries can now afford to undertake every health care activity that might conceivably do someone some good somewhere sometime." ¹

In this issue of the Journal, Anyanwu and associates ² present an analysis of the economic impact of lung transplantation in the United Kingdom. The study compared the costs of 677 thoracic transplantation procedures with the costs accrued by patients on the waiting list during a 4-year period. From these data Anwanyu and associates estimated the incremental cost per life-year gained and the cost per quality-adjusted life-year (QALY) gained. Studies like this often form the basis for resource allocation decisions. Caution must be exercised in extrapolating these results to different health care systems in different countries, however, and also in using this kind of information to allocate resources.

Anwanyu and associates compared the cost of transplantation with the cost of care for listed patients who had not yet undergone transplantation. However, the opportunity to transplant a given patient depends on the organ distribution algorithm in place. In the United States, lungs are distributed within geographic regions primarily according to waiting time. In the United Kingdom, thoracic organs are distributed to centers on a "rotational" system, with centers possessing considerable latitude concerning allocation to individuals on their list. It is therefore likely that as patients become more ill in the United Kingdom, they are more likely to recieve transplants and thus be removed from the list. Patients on the waiting list are . . . [Full Text of this Article]

Related Article

An economic evaluation of lung transplantation

Ani C. Anyanwu, Alistair McGuire, Chris A. Rogers, and A. J. Murday
J. Thorac. Cardiovasc. Surg. 2002 123: 411-420. [Abstract] [Full Text] [PDF]