Economics of transplantation: a review of the literature

BackgroundEconomic issues are important in transplantation. We reviewed the literature about health economics as well as transplantation and highlighted areas for further development.MethodsWe searched the MEDLINE database for the economic literature on kidney, kidney-pancreas, liver, heart, lung, and heart-lung economic studies.ResultsThe evidence that kidney transplantation provides better quality of life over dialysis and decreases costs are consistent. The economic evidence regarding kidney organ-shortage policies (donor action, expanded-criteria donor use) show that these are very cost-effective. Liver, heart, and lung transplantations provide quality-of-life benefits, increase health-care costs, and seem to be generally cost-effective. The cost-effectiveness of different indications, patient groups, and organ-shortage actions needs to be studied in non–kidney transplantation. Across all organs, there is a need to explore the quality-of-life impact of comorbidities and immunosuppressive medications. Surrogate outcomes may become an important tool in pharmacoeconomic research, whereas the use of Markov models and large registries such as the United States Renal Data System will continue to be widely used.ConclusionThe contributions of health economics to transplantation are numerous. Future research are to be expected in the fields of quality of life, cost-effectiveness, insurance coverage, and organ allocation.