Evaluation and selection of candidates for liver transplantation : an economic perspective

Abstract

Background – Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. Objective – To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. Methods – The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. Results – The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24–11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75–10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35–8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. Conclusion – Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.