Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

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 euro69 160 (euro60 682-90 891) in year 2, and euro104 146 (euro83 854-186 412) in year 1. After ITx, costs were euro172 133 (euro122 483-351 407) in the 1st year, euro40 619 (euro3905-113 154) in the 2nd year, and dropped to euro15 743 (euro4408-138 906) in the 3rd year. In stable HPN patients, the costs were euro83 402 (euro35 364-169 146) in the 1st year, euro70 945 (euro31 955-117 913) in the 2nd year, and stabilized to euro60 242 (euro29 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.

Automated summary

Intestinal transplantation (ITx) is initially costly but becomes cost-effective compared to home parenteral nutrition (HPN) in chronic intestinal failure patients by year 4, and cost-saving by year 5.