Abstract
Background
The aim of this project was to model clinically important events experienced by lung transplant patients (from the day after transplant to 5 years or death) and costs associated with these events, and to assess the economic impact of different immunosuppression therapies.
Methods
The population comprised 356 lung transplant patients (223 heart–lung, 102 single lung and 31 double lung) transplanted between April 1984 and December 1997. All patients received a cyclosporine-based triple-immunosuppression protocol. We designed a Markov model that included 3 time periods (0 to 6, 7 to 12, and 13 to 60 months), 5 clinical states (well, acute rejection, cytomegalovirus infection, non-cytomegalovirus infection and bronchiolitis obliterans syndrome), and death. For the well state, cost elements were immunosuppression, prophylaxis, and routine clinic visits. For all other states, cost elements were diagnosis, treatment, and bed days/visits. We excluded costs of the procedure.
Results
The monthly costs associated with the well state decreased over time, from £1,778 ($2,658) in the first 6 months to £503 ($752) in months 7 to 12 and £350 ($523) after the first 12 months. The cost per event of the acute states remained reasonably constant over the 3 periods: £1,850 ($2,766) for rejection, £3,380 ($5,053) for cytomegalovirus, and £2,790 ($4,171) for other infections. The average cost per patient, discounted at 6%, over 5 years was £35,429 ($52,966) (95% range, £1,435 [$2,145] to £67,079 [$100,283]). This estimate is most sensitive to changes in immunosuppression. Substituting tacrolimus for cyclosporine increased 5-year costs by 5%; substituting mycophenolate mofetil for azathioprine increased 5-year costs by 26%.
Conclusions
This model is valuable in estimating the effect of new immunosuppression agents on the costs of follow-up care
The aim of this project was to model clinically important events experienced by lung transplant patients (from the day after transplant to 5 years or death) and costs associated with these events, and to assess the economic impact of different immunosuppression therapies.
Methods
The population comprised 356 lung transplant patients (223 heart–lung, 102 single lung and 31 double lung) transplanted between April 1984 and December 1997. All patients received a cyclosporine-based triple-immunosuppression protocol. We designed a Markov model that included 3 time periods (0 to 6, 7 to 12, and 13 to 60 months), 5 clinical states (well, acute rejection, cytomegalovirus infection, non-cytomegalovirus infection and bronchiolitis obliterans syndrome), and death. For the well state, cost elements were immunosuppression, prophylaxis, and routine clinic visits. For all other states, cost elements were diagnosis, treatment, and bed days/visits. We excluded costs of the procedure.
Results
The monthly costs associated with the well state decreased over time, from £1,778 ($2,658) in the first 6 months to £503 ($752) in months 7 to 12 and £350 ($523) after the first 12 months. The cost per event of the acute states remained reasonably constant over the 3 periods: £1,850 ($2,766) for rejection, £3,380 ($5,053) for cytomegalovirus, and £2,790 ($4,171) for other infections. The average cost per patient, discounted at 6%, over 5 years was £35,429 ($52,966) (95% range, £1,435 [$2,145] to £67,079 [$100,283]). This estimate is most sensitive to changes in immunosuppression. Substituting tacrolimus for cyclosporine increased 5-year costs by 5%; substituting mycophenolate mofetil for azathioprine increased 5-year costs by 26%.
Conclusions
This model is valuable in estimating the effect of new immunosuppression agents on the costs of follow-up care
| Original language | English |
|---|---|
| Pages (from-to) | 474-482 |
| Number of pages | 9 |
| Journal | JOURNAL OF HEART AND LUNG TRANSPLANTATION |
| Volume | 20 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2001 |
| Externally published | Yes |
Keywords
- lung transplantation
- cost benefit analysis
- immunosuppressive therapy