Incorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model

Autor: Nicola McMeekin, Andrew J. Fisher, Alexandros Chrysos, Luke Vale
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Waiting Lists
Cost effectiveness
Cost-Benefit Analysis
medicine.medical_treatment
EVLP
Young Adult
03 medical and health sciences
0302 clinical medicine
Humans
Medicine
Lung transplantation
030212 general & internal medicine
Decision analytic model
Intensive care medicine
Ex-vivo lung perfusion
Aged
Retrospective Studies
Cost–utility analysis
Lung
business.industry
030503 health policy & services
Health Policy
lcsh:Public aspects of medicine
Ex vivo lung perfusion
Analytic model
lcsh:RA1-1270
Middle Aged
respiratory system
Tissue Donors
United Kingdom
Markov model
Economic evaluation
respiratory tract diseases
Transplantation
medicine.anatomical_structure
Tissue and Organ Harvesting
Cost-effectiveness
Quality-Adjusted Life Years
Cost utility analysis
0305 other medical science
business
Lung transplant waiting list
Research Article
Zdroj: BMC Health Services Research, Vol 19, Iss 1, Pp 1-14 (2019)
McMeekin, N, Chrysos, A, Vale, L & Fisher, A J 2019, ' Incorporating ex-vivo lung perfusion into the UK adult lung transplant service : an economic evaluation and decision analytic model ', BMC Health Services Research, vol. 19, no. 326, 326 . https://doi.org/10.1186/s12913-019-4154-6
BMC Health Services Research
ISSN: 1472-6963
Popis: BackgroundAn estimated 20–30% of end-stage lung disease patients awaiting lung transplant die whilst on the waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom.MethodsWe estimated the cost-effectiveness of a UK adult lung transplant service combining both standard and Ex-Vivo Lung Perfusion transplants compared to a service including only standard lung transplants. A Markov model was developed and populated with a combination of DEVELOP-UK, published and clinical routine data, and extrapolated to a lifetime horizon. Probabilistic sensitivity and scenario analyses were used to explore uncertainty in the final outcomes.ResultsBase-case model results estimated life years gained of 0.040, quality-adjusted life-years (QALYs) gained of 0.045 and an incremental cost per QALY of £90,000 for Ex-Vivo Lung Perfusion. Scenario analyses carried out suggest that an improved rate of converting unusable donor lungs using Ex-Vivo Lung Perfusion, similar resource use post-transplant for both standard and EVLP lung transplant and applying increased waiting list costs would reduce ICERs to approximately £30,000 or below.ConclusionDEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung transplant service is more effective, increasing the number of donor lungs available for transplant, but would not currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating Ex-vivo lung perfusion would be considered cost-effective .Trial registrationISRCTN registry number: ISRCTN44922411.Date of registration: 06/02/2012.Retrospectively registered.
Databáze: OpenAIRE
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