期刊
JOURNAL OF HEART AND LUNG TRANSPLANTATION
卷 40, 期 12, 页码 1625-1640出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.healun.2021.08.007
关键词
lung transplantation; cost-benefit analysis; economic evaluation; scoping review; health care costs
The scoping review focused on summarizing and categorizing the available evidence of the costs and cost-effectiveness of lung transplantation, identifying common study topics and factors contributing to variation in cost assessments. The best available cost-utility estimates suggest potential cost-effectiveness of lung transplant versus waitlist under certain circumstances, but further high-quality cost-utility analyses are needed to confirm this and establish the economic viability of current lung transplantation practices.
BACKGROUND: Evaluation of the joint clinical and economic impacts of lung transplant and associated technologies is crucial for evidence-informed decision-making and wise allocation of scarce healthcare resources. We performed a scoping review to summarize and categorize the available evidence of the costs and cost-effectiveness of lung transplantation. METHODS: A systematic search of MEDLINE, EMBASE, NHS EED, and EconLit was performed to identify studies involving lung transplantation for adults that measured costs, cost-effectiveness, or which described themselves as economic evaluations. A scoping review was performed in adherence to the framework described by Arksey & O'Malley. Risk of bias was assessed in included studies using the ECOBIAS and CHEC-list tools. RESULTS: In total, 324 studies were identified, of which 28 met inclusion criteria. Cost-utility estimates of lung transplant versus waitlist, from the healthcare payer perspective and a time-horizon of at least 10-years ranged between $42,459 and $154,051 per quality-adjusted life year. Common topics of study included lung transplant versus waitlist care, immunosuppression, organ retrieval and allocation, and mechanical life support. CONCLUSIONS: Sources of variation in costs-assessments and economic evaluations included differences in the type of study performed, payer perspective adopted, study time horizon, and variation in clinical practice. The best available cost-utility estimates for lung transplant versus waitlist may represent cost-effectiveness under some circumstances, but high-quality evidence is lacking. Further cost-utility analyses, with sufficient methodologic rigour, are required to overcome the observed variation in results and confirm cost-effectiveness of the current standard of care in lung transplantation. J Heart Lung Transplant 2021;40:1625-1640 (c) 2021 International Society for Heart and Lung Transplantation. All rights reserved.
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