Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease

BMC Pediatrics

Research

Oraluck Pattanaprateep¹  Boonyanurak Sihaklang²  Pornthep Tanpowpong³  Napapat Butsriphum³  Songpon Getsuwan³  Suporn Treepongkaruna³  Chatmanee Lertudomphonwanit³  Chollasak Thirapattaraphan⁴ 

[1] Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phayathai, Ratchathewi, Bangkok, Thailand;Department of Pediatrics, Institute of Medicine, Suranaree University of Technology, Nakhon Ratchasima, Thailand;Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phayathai, Ratchathewi, Bangkok, Thailand;Ramathibodi Excellence Center in Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;Ramathibodi Excellence Center in Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;

关键词: Biliary atresia;    Liver cirrhosis;    Liver transplantation;    Children;    Cost-effectiveness analysis;    Hospital costs;    Mortality;   

DOI  :  10.1186/s12887-023-04270-0

 received in 2023-05-30, accepted in 2023-08-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTiming for liver transplantation (LT) in biliary atresia (BA) children with end-stage liver disease (ESLD) is associated with all-cause mortality. The cut-off value of pediatric end-stage liver disease (PELD) score for LT consideration varies across institutions. We aimed to determine the cost-effectiveness of LT to prevent death among BA children registered on the waiting list with different severities of ESLD.MethodsSubjects were BA children aged < 12 years at a transplant center between 2010 and 2021. A decision tree was developed for cost-effectiveness analysis from a hospital perspective to compare all-cause death between patients initially registered with a low PELD score (< 15) and a high PELD score (≥ 15). Each patient’s direct medical cost was retrieved from the beginning of registration until 5 years after LT, adjusted with an inflation rate to 2022 Thai Baht (THB).ResultsAmong 176 children, 138 (78.4%) were initially registered with the high PELD score. The cost and mortality rate of the low PELD score group (THB1,413,424 or USD41,904 per patient and 31.6% mortality) were less than the high PELD score group (THB1,781,180 or USD52,807 per patient and 47.9% mortality), demonstrating the incremental cost-effectiveness ratio (ICER) of THB2,259,717 or USD66,994 per death prevented. The cost of early post-operative admission had the highest effect on the ICER. Considering the break-even analysis, cost among children initially registered at the low PELD score was also less expensive over time.ConclusionsRegistration for LT at PELD score < 15 was more cost-effective to prevent death among BA children with ESLD.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

12888_2023_5172_Article_IEq50.gif

13690_2023_1177_Fige_HTML.png

12936_2023_4724_Article_IEq75.gif

40677_2023_249_Article_IEq13.gif