Economics of transplantation: a review of the literature
Abstract
Background
Economic issues are important in transplantation. We reviewed the literature about health economics as well as transplantation and highlighted areas for further development.
Methods
We searched the MEDLINE database for the economic literature on kidney, kidney-pancreas, liver, heart, lung, and heart-lung economic studies.
Results
The evidence that kidney transplantation provides better quality of life over dialysis and decreases costs are consistent. The economic evidence regarding kidney organ-shortage policies (donor action, expanded-criteria donor use) show that these are very cost-effective. Liver, heart, and lung transplantations provide quality-of-life benefits, increase health-care costs, and seem to be generally cost-effective. The cost-effectiveness of different indications, patient groups, and organ-shortage actions needs to be studied in non–kidney transplantation. Across all organs, there is a need to explore the quality-of-life impact of comorbidities and immunosuppressive medications. Surrogate outcomes may become an important tool in pharmacoeconomic research, whereas the use of Markov models and large registries such as the United States Renal Data System will continue to be widely used.
Conclusion
The contributions of health economics to transplantation are numerous. Future research are to be expected in the fields of quality of life, cost-effectiveness, insurance coverage, and organ allocation.
aCenter for Outcomes Research, St Louis University School of Medicine, St Louis, MO 63104, USA
bInstitute de Pharmacie Industrielle de Lyon, Lyon University, 69373 Lyon, France
Corresponding author. St Louis University Center for Outcomes Research, St Louis, MO 63104, USA. Tel.: +1 314 977 9476; fax: +1 314 977 1101.
ABSTRACT