Northup Patrick G, Abecassis Michael M, Englesbe Michael J, Emond Jean C, Lee Vanessa D, Stukenborg George J, Tong Lan, Berg Carl L
Department of Medicine, University of Virginia, Charlottesville, VA, USA.
Liver Transpl. 2009 Feb;15(2):148-62. doi: 10.1002/lt.21671.
Using outcomes data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, we performed a cost-effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality-adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4-QALY survival and a mean cost of $151,613, and waiting list with possible DDLT or LDLT offered 4.9-QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost-effectiveness ratio (ICER) of $35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost-effective compared to medical management of cirrhosis over our 10-year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost.
利用成人对成人活体肝移植队列研究的结果数据，我们进行了一项成本效益分析，探讨活体肝移植（LDLT）的成本和效益。我们开发了一个多阶段马尔可夫决策分析模型，用于分析10年内的治疗方案，包括仅进行药物治疗（策略1）、等待可能的尸体供肝移植（DDLT；策略2）以及等待可能的LDLT或DDLT（策略3）。失代偿期肝硬化患者接受药物治疗的生存质量调整生命年（QALY）为2.0年，平均成本为65,068美元；等待可能的DDLT的患者生存质量调整生命年为4.4年，平均成本为151,613美元；等待可能的DDLT或LDLT的患者生存质量调整生命年为4.9年，平均成本为208,149美元。策略2相对于策略1的增量成本效益比（ICER）为35,976美元，而策略3相对于策略2的增量成本效益比为106,788美元。平均而言
