Cost-effectiveness analysis of liver transplantation in biliary atresia according to the severity of end-stage liver disease

• Published in: BMC pediatrics 2023-09, Vol.23 (1), p.1-10, Article 439
• Main Authors: Sihaklang, Boonyanurak, Getsuwan, Songpon, Pattanaprateep, Oraluck, Butsriphum, Napapat, Lertudomphonwanit, Chatmanee, Tanpowpong, Pornthep, Thirapattaraphan, Chollasak, Treepongkaruna, Suporn
• Format: Article
• Language: English
• Subjects: Biliary atresia; Care and treatment; Children; Children & youth; Cost analysis; Cost-effectiveness analysis; Diagnosis; Evaluation; Health care expenditures; Hospital costs; Liver; Liver cirrhosis; Liver diseases; Liver transplantation; Liver transplants; Medical care, Cost of; Mortality; Pediatrics; Public health; Registration; Transplantation; Transplants & implants
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-023-04270-0

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 ([greater than or equal to] 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. Keywords: Biliary atresia, Liver cirrhosis, Liver transplantation, Children, Cost-effectiveness analysis, Hospital costs, Mortality