Economic Evaluations of Organ Transplantations - A Systematic Literature Review

Abstract

The purpose of this study is threefold; 1) to establish the current level of knowledge regarding cost-effectiveness of organ transplantation, 2) to identify knowledge gaps, and 3) to suggest a framework for future studies. A systematic literature review of economic evaluations of transplantations of solid organs was conducted in October 2010. Economic evaluations published since 2000 and reviews published since 1987 for kidney, liver, lung, heart, pancreas, and small bowel transplantations were collected. The studies were analysed regarding results and study characteristics. The review demonstrates a lack of economic evaluations for all included organ transplantations. The cost-effectiveness of kidney transplantation, and to some extent liver transplantation, compared to a non-transplant alternative appears to be established. However, cost-effectiveness for transplantation of lung, heart, pancreas, and small bowel can neither be established nor rejected based on earlier studies. Many of the included studies were limited in a number of ways; e.g. using short follow-up period, failing to account for sample selection in treatment groups, comparing to unrealistic alternatives, lacking important cost categories, and using a limiting perspective. Recommendation for future studies are, besides accounting for the above, to conduct sub-group analyses as patient and disease characteristics, among other things, has been shown to affect the cost-effectiveness of organ transplantation.

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