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Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults. Transplantation 2021; 105:897-904. [PMID: 32453254 DOI: 10.1097/tp.0000000000003328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intestinal transplantation (ITx) is the most expensive abdominal organ transplant. Detailed studies about exact costs and cost-effectiveness compared to home parenteral nutrition (HPN) therapy in chronic intestinal failure are lacking. The aim is to provide an in-depth analysis of ITx costs and evaluate cost-effectiveness compared to HPN. METHODS To calculate costs before and after ITx, costs were analyzed in 12 adult patients. To calculate the costs of patients with uncomplicated chronic intestinal failure, 28 adults, stable HPN patients were studied. Total costs including surgery, admissions, diagnostics, HPN therapy, medication, and ambulatory care were included. Median (range) costs are given. RESULTS Costs before ITx were €69 160 (€60 682-90 891) in year 2, and €104 146 (€83 854-186 412) in year 1. After ITx, costs were €172 133 (€122 483-351 407) in the 1st year, €40 619 (€3905-113 154) in the 2nd year, and dropped to €15 743 (€4408-138 906) in the 3rd year. In stable HPN patients, the costs were €83 402 (€35 364-169 146) in the 1st year, €70 945 (€31 955-117 913) in the 2nd year, and stabilized to €60 242 (€29 161-238 136) in the 3rd year. CONCLUSIONS ITx, although initially very expensive, is cost-effective compared to HPN in adults by year 4, and cost-saving by year 5.
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Roskott AM, Groen H, Rings EHHM, Haveman JW, Ploeg RJ, Serlie MJ, Wanten G, Krabbe PFM, Dijkstra G. Cost-effectiveness of intestinal transplantation for adult patients with intestinal failure: a simulation study. Am J Clin Nutr 2015; 101:79-86. [PMID: 25527753 DOI: 10.3945/ajcn.114.083303] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Home parenteral nutrition (HPN) and intestinal transplantation (ITx) are the 2 treatment options for irreversible intestinal failure (IF). OBJECTIVE This study simulated the disease course of irreversible IF and both of these treatments--HPN and ITx--to estimate the cost-effectiveness of ITx. DESIGN We simulated IF treatment in adults as a discrete event model with variables derived from the Dutch Registry of Intestinal Failure and Intestinal Transplantation, the Intestinal Transplant Registry, hospital records, the literature, and expert opinions. Simulated patients were enrolled at a rate of 40/mo for 10 y. The maximum follow-up was 40 y. Survival was simulated as a probabilistic function. ITx was offered to 10% of patients with <12 mo of remaining life expectancy with HPN if they did not undergo ITx. Costs were calculated according to Dutch guidelines, with discounting. We evaluated the cost-effectiveness of ITx by comparing models conducted with and without ITx and by calculating the cost difference per life-year gained [incremental cost-effectiveness ratio (ICER)]. RESULTS The average survival was 14.6 y without ITx and 14.9 y with ITx. HPN costs were €13,276 for treatment introduction, followed by €77,652 annually. The costs of ITx were ∼€73,000 during the first year and then €13,000 annually. The ICER was €19,529 per life-year gained. CONCLUSION Our simulations show that ITx slightly improves survival of patients with IF in comparison with HPN at an additional cost of €19,529 per life-year gained.
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Affiliation(s)
- Anne Margot Roskott
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Henk Groen
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Edmond H H M Rings
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Jan Willem Haveman
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Rutger J Ploeg
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Mireille J Serlie
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Geert Wanten
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Paul F M Krabbe
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Gerard Dijkstra
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
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Update on intestinal rehabilitation after intestinal transplantation. Curr Opin Organ Transplant 2009; 14:267-73. [PMID: 19349866 DOI: 10.1097/mot.0b013e32832ac0f5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The past decade has seen improvements in patient selection and a greater range of surgical procedures available to patients with intestinal failure, and this, combined with more effective immunosuppressive regimens, has transformed survival after intestinal transplantation (ITx). Much more is known about optimizing rehabilitation of the engrafted intestine in the first 12 months after transplant, but it is also becoming apparent that there are some long-term health issues to consider. RECENT FINDINGS The key issues in rehabilitation of ITx are the immunogenic nature of the intestinal graft, which means a higher risk of rejection and necessitates relatively high levels of immune suppression that promotes infections, including Epstein-Barr virus-driven lymphoma, viral gastroenteritis and renal impairment; and those related to the specifics of an intestinal allograft (nutritional support, chylous ascites, growth, food allergy, fat soluble vitamin deficiencies, metabolic bone disease). In this article, recent publications about approaches for establishing nutrition and methods for monitoring the health of the ITx patient are reviewed. SUMMARY ITx appears to be cost-effective compared with parenteral nutrition, but ITx recipients continue to be vulnerable to infections, nutritional deficiencies and rejection over the long-term and, therefore, require support from and involvement of a multidisciplinary team for patients to become safely integrated with their local community.
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