Mendonça Luis, Perelman Julian, Rodrigues Vanessa, Fragata José
Hospital das Forças Armadas, Lisbon, Portugal,
Eur J Health Econ. 2014 Sep;15(7):767-72. doi: 10.1007/s10198-013-0522-z. Epub 2013 Aug 3.
We analyzed the costs and outcomes of lung transplant in Portugal and its evolution since it was first performed in 2000.
Data were collected for all patients waiting for transplant from 31 December 2000 until 31 December 2010 (n = 61). Patients waiting for transplant were used as the comparison group. We calculated the mean restricted survival time using the Kaplan-Meier estimation method. The time horizon was closed upon the death of the last surviving patient. Costs and consequences were discounted at 5% per annum. We calculated the incremental cost-effectiveness ratio of transplant as compared to no transplant. Deterministic and probabilistic sensitivity analyses were performed. We tested volume-outcome effects using a parametric survival regression.
The cost of lung transplantation was 77,223€ per QALY and 121,276€ per life-year. Assuming a 50,000€/QALY willingness-to-pay, lung transplant would be cost-effective with a 37% probability. Survival improved substantially from 5.15 years over the 2001-2010 period to 6.94 years for the 2008-2010 period. When restricting our analysis to the 2008-2010 period, the cost-effectiveness ratio decreased to €79,016 per life-year gained and €69,241 per QALY. Survival was significantly associated with the number of procedures performed.
Although above commonly accepted cost-effectiveness thresholds, the economic value of lung transplant holds promise in Portugal due to the large improvement in survival over the 2001-2010 period. The life-threatening character of the motivating conditions, the absence of alternative treatment, and equity concerns should be also accounted for when assessing the "value for money" of lung transplant.
我们分析了葡萄牙肺移植的成本和结果及其自2000年首次开展以来的演变情况。
收集了2000年12月31日至2010年12月31日期间所有等待移植患者的数据（n = 61）。将等待移植的患者作为对照组。我们使用Kaplan-Meier估计方法计算了平均受限生存时间。时间范围在最后一名存活患者死亡时结束。成本和后果按每年5%进行贴现。我们计算了移植与未移植相比的增量成本效益比。进行了确定性和概率性敏感性分析。我们使用参数生存回归测试了容量-结果效应。
肺移植的成本为每质量调整生命年77,223€，每生命年121,276€。假设支付意愿为50,000€/质量调整生命年，肺移植具有成本效益的概率为37%。生存率从2001 - 2010年期间的5.15年大幅提高到2008 - 2010年期间的6.94年。当将分析限制在2008 - 2010年期间时，成本效益比降至每获得的生命年79,016€，每质量调整生命年69,241€。生存率与所进行的手术数量显著相关。
尽管高于普遍接受的成本效益阈值，但由于2001 - 2010年期间生存率的大幅提高，肺移植在葡萄牙具有经济价值。在评估肺移植的“性价比”时，还应考虑激发条件的危及生命特征、缺乏替代治疗以及公平性问题。
