Cost of a quality-adjusted life year in liver transplantation: the influence of the indication and the model for end-stage liver disease score

Liver Transpl. 2011 Nov;17(11):1333-43. doi: 10.1002/lt.22388.


Cost issues in liver transplantation (LT) have received increasing attention, but the cost-utility is rarely calculated. We compared costs per quality-adjusted life year (QALY) from the time of placement on the LT waiting list to 1 year after transplantation for 252 LT patients and to 5 years after transplantation for 81 patients. We performed separate calculations for chronic liver disease (CLD), acute liver failure (ALF), and different Model for End-Stage Liver Disease (MELD) scores. For the estimation of QALYs, the health-related quality of life was measured with the 15D instrument. The median costs and QALYs after LT were €141,768 and 0.895 for 1 year and €177,618 and 3.960 for 5 years, respectively. The costs of the first year were 80% of the 5-year costs. The main cost during years 2 to 5 was immunosuppression drugs (59% of the annual costs). The cost/QALY ratio improved from €158,400/QALY at 1 year to €44,854/QALY at 5 years, and the ratio was more beneficial for CLD patients (€42,500/QALY) versus ALF patients (€63,957/QALY) and for patients with low MELD scores versus patients with high MELD scores. Although patients with CLD and MELD scores > 25 demonstrated markedly higher 5-year costs (€228,434) than patients with MELD scores < 15 (€169,541), the cost/QALY difference was less pronounced (€59,894/QALY and €41,769/QALY, respectively). The cost/QALY ratio for LT appears favorable, but it is dependent on the assessed time period and the severity of the liver disease.

MeSH terms

  • Adult
  • Cholangitis, Sclerosing / economics
  • Cholangitis, Sclerosing / mortality
  • Cholangitis, Sclerosing / surgery
  • Cost-Benefit Analysis / economics
  • Cost-Benefit Analysis / statistics & numerical data
  • Drug Costs / statistics & numerical data
  • Female
  • Finland / epidemiology
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Immunosuppressive Agents / economics
  • Liver Cirrhosis, Biliary / economics
  • Liver Cirrhosis, Biliary / mortality
  • Liver Cirrhosis, Biliary / surgery
  • Liver Diseases, Alcoholic / economics
  • Liver Diseases, Alcoholic / mortality
  • Liver Diseases, Alcoholic / surgery
  • Liver Failure* / economics
  • Liver Failure* / mortality
  • Liver Failure* / surgery
  • Liver Transplantation / economics*
  • Liver Transplantation / mortality*
  • Male
  • Middle Aged
  • Models, Statistical
  • Quality of Life*
  • Quality-Adjusted Life Years*


  • Immunosuppressive Agents