Incorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model

Nicola McMeekin, Alexandros Chrysos, Luke Vale, Andrew J. Fisher

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
114 Downloads (Pure)

Abstract

Background
An estimated 20–30% of end-stage lung disease patients awaiting lung transplant die whilst on the waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom.

Methods
We estimated the cost-effectiveness of a UK adult lung transplant service combining both standard and Ex-Vivo Lung Perfusion transplants compared to a service including only standard lung transplants. A Markov model was developed and populated with a combination of DEVELOP-UK, published and clinical routine data, and extrapolated to a lifetime horizon. Probabilistic sensitivity and scenario analyses were used to explore uncertainty in the final outcomes.

Results
Base-case model results estimated life years gained of 0.040, quality-adjusted life-years (QALYs) gained of 0.045 and an incremental cost per QALY of £90,000 for Ex-Vivo Lung Perfusion. Scenario analyses carried out suggest that an improved rate of converting unusable donor lungs using Ex-Vivo Lung Perfusion, similar resource use post-transplant for both standard and EVLP lung transplant and applying increased waiting list costs would reduce ICERs to approximately £30,000 or below.

Conclusion
DEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung transplant service is more effective, increasing the number of donor lungs available for transplant, but would not currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating Ex-vivo lung perfusion would be considered cost-effective .

Trial registration
ISRCTN registry number: ISRCTN44922411.

Date of registration: 06/02/2012.

Retrospectively registered.
Original languageEnglish
Article number326
Number of pages14
JournalBMC Health Services Research
Volume19
Issue number326
DOIs
Publication statusPublished - 22 May 2019

Keywords

  • Ex-vivo lung perfusion
  • EVLP
  • Lung transplantation
  • Lung transplant waiting list
  • Cost-effectiveness
  • Cost utility analysis
  • Markov model
  • Decision analytic model
  • Economic evaluation

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