Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease
Issued Date
2023-09-02
Resource Type
eISSN
14712431
Scopus ID
2-s2.0-85169522152
Pubmed ID
37660000
Journal Title
BMC pediatrics
Volume
23
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC pediatrics Vol.23 No.1 (2023) , 439
Suggested Citation
Sihaklang B., Getsuwan S., Pattanaprateep O., Butsriphum N., Lertudomphonwanit C., Tanpowpong P., Thirapattaraphan C., Treepongkaruna S. Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease. BMC pediatrics Vol.23 No.1 (2023) , 439. doi:10.1186/s12887-023-04270-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/89607
Title
Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease
Other Contributor(s)
Abstract
BACKGROUND: Timing 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. METHODS: Subjects 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). RESULTS: Among 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. CONCLUSIONS: Registration for LT at PELD score < 15 was more cost-effective to prevent death among BA children with ESLD.