Economic Evaluation and Budget Impact Analysis of Liver Transplantation among Thai Adults in Universal Health Insurance Coverage in Thailand

Abstract

Liver transplantation (LT) is an essential medical treatment for those who are diagnosed with either acute or chronic liver failure. As a standard medical care in many developed countries, liver transplantation is cost-effective for patients diagnosed with liver failure, and the 5-year survival rate is greater than 80%. There are two types donors of liver transplantation: (a) cadaveric donor and (b) living donor. The objectives of this study were to conduct economic evaluation on liver transplantation for patients aged over 18 years under the universal health coverage (UHC) scheme, and to estimate the budget impact of introducing the liver transplantation into the UHC benefit package, as well as to propose policy recommendations to the National Health Security Office (NHSO) Benefit Package (or UCBP) Subcommittee and NHSO Executive Board for their considerations. The study methods included (1) comprehensive literature review on demand for and supply of liver transplantation in adults, (2) costing study on liver transplantation from either cadaveric or living donors, (3) interview with experts and medical specialists regarding costs borne by the hospitals and patients both prior to and after liver transplantation, (4) interviews with patients who were in the waiting lists for receiving organ donation and those who already got liver transplantation, and (5) mathematical modeling for economic evaluation on the liver transplantation. It was found that expenses for the first year of liver transplantation were the highest. It costed around 500,000-700,000 Thai baht (13,889 - 19,444 USD) for the operation in the first year, and after that the expenses were for immunosuppressive medicines and antibiotics to prevent organ rejection and infection respectively. From economic evaluation, liver transplantation might be cost-effective for patients with over 10-year survival after receiving the operation if the criteria of 1 gross domestic product (GDP) per quality adjusted life year (QALY gained) of the UCBP subcommittee were applied. The incremental cost-effectiveness ratio of liver transplantation was around 254,558 baht (7,482 USD) per QALY gained, which is higher than 1 GDP per capita at 160,000 THB or 4,703 USD. It is clear that liver transplantation can result in a considerable amount of quality of life (QOL). However, high costs of operation and expensive immunosuppressive medicines including antibiotics lead to less cost-effectiveness of liver transplantation in economic perspectives. Negotiation to reduce the prices of immunosuppressive medicines and antibiotics can improve the cost-effectiveness of liver transplantation.