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- W2016561310 abstract "Background: Given continuing organ scarcity, efforts to increase utilization of expanded criteria livers, including donation after cardiac death (DCD) grafts, have gained foothold. Yet prior studies have failed to identify which group of end-stage liver disease patients are the most appropriate recipients for DCD liver grafts. We performed a decision analysis to examine the potential benefit and cost effectiveness of DCD liver transplantation compared with remaining on the waitlist. Methods: We constructed a Markov model comparing DCD liver transplantation with remaining on the waitlist and potentially receiving a donation after brain death (DBD) liver. We examined differences in quality-adjusted life-years (QALY's) and costs according to the candidate's model for end-stage liver disease (MELD) score. Sensitivity analyses were performed by varying parameters both individually and simultaneously within a probabilistic sensitivity analysis. Results: For candidates with a MELD $2million/QALY. Patients with MELD>30 also derived a survival benefit from DCD transplantation. This was associated with an additional $76 K and 0.24 QALY's and resulting in an ICER of $318 K/QALY. The probability of receiving a DBD liver according to MELD score is one critical parameter considered. In the MELD >30 cohort, DCD transplantation was associated with improved survival unless probability of receiving a DBD transplant exceeded 70% (expected average probability=48% according to SRTR). For the MELD 21-30 cohort, staying on the waiting list became the more effective strategy in terms of survival when the monthly probability of DBD transplant exceeded 24% (compared with expected probability=19%). Conclusions: For candidates with a MELD <21, DCD transplantation results in worse survival compared with remaining on the waiting list. Patients with a MELD score of >20 did have improved survival with DCD liver transplantation. However, given the small incremental benefits in survival, the incremental cost effectiveness ratios were considerably larger than typical willingness-to-pay thresholds. In the current era of healthcare reform and focus on comparative effectiveness, careful consideration of the lack of cost-effectiveness of DCD liver transplantation needs to be incorporated into the decision to utilize these grafts despite federal mandates promoting their use." @default.
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- W2016561310 date "2010-02-01" @default.
- W2016561310 modified "2023-10-16" @default.
- W2016561310 title "The Incremental Benefit of Donation after Cardiac Death Liver Transplantation According to Candidate Disease Severity: A Decision Analysis" @default.
- W2016561310 doi "https://doi.org/10.1016/j.jss.2009.11.100" @default.
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