Paillet Carole, Chamouard Valérie, Nageotte Alain, Boillot Olivier, Colin Cyrille, Dumortier Jérôme
Pharmacie, Hôpital Edouard Herriot, Lyon (69).
Presse Med. 2007 Feb;36(2 Pt 1):203-10. doi: 10.1016/j.lpm.2006.07.009. Epub 2007 Jan 8.
Alcoholic cirrhosis and viral (especially hepatitis C) cirrhosis account for 50% of liver transplantation indications. The aim of our study was to evaluate the cost of liver transplantation from the hospital's perspective, according to indication.
This retrospective study at a university hospital included 60 patients (cause of liver disease: alcoholic or hepatitis C-induced cirrhosis) who underwent liver transplantation between 1996 and 1999. All patients received the liver of brain-dead donors. The outcome measure was the cost of hospitalization from admission for transplantation through two years afterwards. The study does not include the costs of pre-transplantation evaluation or organ procurement. To calculate medical costs, we collected data about pharmaceutical use and laboratory tests for each patient. Logistic costs were calculated from French data for diagnosis-related groups, according to length of stay. Consultations and admissions in the two years after transplantation were collected, and their costs calculated.
Length of stay for transplantation (mean: 24 days, range 11-66) and costs (average 40 keuro per patient, range: 27.8-75.7, i.e., 52 keuro after escalation to 2006 levels) were similar. The cost of transplantation was higher (p=0.002) for Child C patients (mean: 46 keuro per patient, range: 31,1-72,8). Costs of follow-up after transplant (mean 5.4 keuro per patient, range: 0.87-19.7) varied, with consultation costs higher (p=0.002) in the alcoholic cirrhosis group (0.38 keuro versus 0.3 keuro) and hospitalization more expensive (p=0.0496) for the viral cirrhosis group (6 keuro versus 4,6 keuro).
We found that length of stay was the most important determinant of hospital costs for liver transplantation and that the indication for transplantation has a slight influence on resource utilization during the first two years after surgery.
酒精性肝硬化和病毒性（尤其是丙型肝炎）肝硬化占肝移植指征的50%。我们研究的目的是从医院角度，根据指征评估肝移植的成本。
这项在一家大学医院开展的回顾性研究纳入了1996年至1999年间接受肝移植的60例患者（肝病病因：酒精性或丙型肝炎所致肝硬化）。所有患者均接受脑死亡供体的肝脏。结局指标是从移植入院至术后两年的住院费用。该研究不包括移植前评估或器官获取的费用。为计算医疗成本，我们收集了每位患者的用药和实验室检查数据。后勤成本根据住院时间，依据法国诊断相关组的数据进行计算。收集了移植后两年的会诊和住院情况，并计算其费用。
移植住院时间（平均：24天，范围11 - 66天）和费用（平均每位患者40千欧元，范围：27.8 - 75.7千欧元，即按2006年水平换算后为52千欧元）相似。Child C级患者的移植费用更高（p = 0.002）（平均每位患者46千欧元，范围：31.1 - 72.8千欧元）。移植后随访费用（平均每位患者5.4千欧元，范围：0.87 - 19.7千欧元）各不相同，酒精性肝硬化组的会诊费用更高（p = 0.002）（0.38千欧元对0.3千欧元），病毒性肝硬化组的住院费用更高（p = 0.0496）（6千欧元对4.6千欧元）。
我们发现住院时间是肝移植医院成本的最重要决定因素，且移植指征对术后头两年的资源利用有轻微影响。
