The Actual Operative Costs of Liver Transplantation and Normothermic Machine Perfusion in a Canadian Setting
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ORIGINAL RESEARCH ARTICLE
The Actual Operative Costs of Liver Transplantation and Normothermic Machine Perfusion in a Canadian Setting Alexandria N. Webb1 · Dayne L. Izquierdo2 · Dean T. Eurich3 · A. M. James Shapiro1,2 · David L. Bigam1 Accepted: 30 October 2020 © The Author(s) 2020
Abstract Background Liver transplantation is an effective treatment for end-stage liver disease. However, waiting lists continue to lengthen as demand exceeds supply. Use of extended criteria donors has helped but is associated with increased rates of complications. The application of normothermic machine perfusion (NMP) has been shown to be protective, especially in more marginal grafts. Despite this benefit, no cost-effectiveness studies have been published. Objective This study serves as a prelude to a cost-effectiveness analysis of the costs of liver procurement, transplantation, and machine perfusion in a Canadian setting. Methods The total costs were calculated for 106 in-province procurements, the set cost for 237 out-of-province procurements, and 343 liver transplantations. These costs include overheads, supplies, anaesthesia technologist and nursing salaries, and physician billings. Base and modified costs for all procedures were calculated, with consideration of physician billing modifiers. The total cost per run of NMP was calculated, with a range based on variations in the exchange rates for Great British pounds (₤) to Canadian dollars ($Can), year 2019 values. Results Costs were $Can30,770.22 for in-province and $Can44,636.73 for out-of-province liver procurement and transplantation. These increased to $Can35,659.22 and 48,076.18 when considering modifiers. The minimum cost per NMP run was $Can18,593.02. Conclusions Although the cost per run is substantial, NMP could potentially lead to cost savings by decreasing night-time salary premiums, complications, and patient length of stay. A formal cost-effectiveness study of NMP in liver transplantation is underway to help clarify the financial benefit or burden of this new technology.
Key Points for Decision Makers This paper defined actual costs per run for normothermic machine perfusion used in liver transplantation from a Canadian single-payer perspective as well as the potential cost savings accrued through a transition from nighttime to daytime transplant surgery hours. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s41669-020-00241-8) contains supplementary material, which is available to authorized users. * Alexandria N. Webb [email protected] 1
Department of Surgery, University of Alberta, 8440 112 St, Edmonton, AB T6G 2B7, Canada
2
Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
3
School of Public Health, University of Alberta, Edmonton, AB, Canada
This paper provides insight into the actual costs for transplant surgery and the per run cost of normothermic machine perfusion. This is the prelude to a formal cost-effectiveness analysis to inform healthcare deci
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