Cost-benefit analysis of deceased donor organ transplantation: an economic evaluation

Background: Each year around 4,500 people in the UK receive an organ transplant. These surgeries can be life changing and life extending for patients but are also associated with significant costs for the health service. However, by reducing the need for other expensive interventions involved in non-transplant care for organ failure, such as dialysis, some of these costs may be recovered. Methods: We assessed the lifetime costs and benefits associated with transplantation focussing on deceased donor adult transplants for kidneys, livers, hearts, and lungs. We incorporated costs of organ retrieval, surgery, post-transplant secondary care, and medications, as well as impacts on quality and duration of life. These were compared to the cost of managing patients with end-stage organ failure for whom no transplant occurs. Results: Kidney transplants were found to be cost saving with lifetime costs approximately 220,000 GBP lower than alternative treatment. Heart transplants and liver transplants were found to be more cost-effective than thresholds used by NICE for new medicines at approximately 17,000 GBP to 18,000 GBP per quality adjusted life year gained. Lung transplants were the least cost-effective organ transplant with a cost per quality adjusted life year gained of over 50,000 GBP. Conclusions: Although transplants can be costly, not providing a transplant to a patient who needs one also brings significant costs. Kidney transplants can save the health system money by reducing the need for dialysis. Increasing the number of kidney's available for transplant could save the NHS money whilst saving and improving lives.