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OUTCOMES AND HEALTHCARE COSTS FOR NOVA SCOTIANS REFERRED TO THE ATLANTIC MULTI-ORGAN TRANSPLANT PROGRAM (MOTP) BETWEEN 1996 AND 2002

C Skedgel¹, M Molinari², M Walsh², B Nashan², KM Peltekian
Departments of Medicine (¹Office of Outcomes Research, and Health Economics); ²Surgery, Dalhousie University, and Atlantic Multi-Organ Transplant Program, Capital District Health Authority, Halifax, Nova Scotia

As estimated by Health Canada, there has been growing need for liver transplantation in Atlantic Canada. Accurate estimates of healthcare costs related to transplantation should include not only the transplant procedure but also the pre- and post-transplant healthcare utilization. Our objective was to calculate the long-term costs and outcomes for all Nova Scotians referred to MOTP compared to age-sex matched comparator cohort.
METHODS: Clinical data (including referral and liver transplant dates) from MOTP were linked through Dalhousie Population Health Research Unit to the administrative data from 1996/97 to 2003/04. This administrative database includes only those covered by Nova Scotia Medical Services Insurance. A 2:1 age-sex matched comparison cohort without liver disease was also drawn. Utilization data included physician billings (including shadow billings) and hospital discharges. Hospital case costs were derived from the Ontario Case Cost Initiative database based on primary diagnosis and procedure codes. Date of death for both MOTP and comparison cohorts were extracted from Nova Scotia Vital Statistics data.
RESULTS: 404 Nova Scotians were referred to MOTP, with 173 undergoing liver transplantation between 1996 and 2001. Mean age was 51 yrs (with 59% males) for both MOTP and the comparison cohort. Kaplan-Meier survival curves showed a 5-yr survival of 82% in the transplanted group and 47% in the non-transplanted group, compared to 97% in the comparator. Relative to the comparator, the net cost differential in MOTP-referred cohort was $166,882 per patient over the 10 yrs following referral date. Within MOTP-referred cohort, the net cost differential was -$2,945 in patients transplanted versus those not transplanted over the 5 yrs following referral. Considering only transplanted patients, the average cost differential was $224,000 greater than comparator over a period beginning 2 yrs pre- and 10 yrs post-transplant.
CONCLUSION: In Canada, this is the first time long-term differential costs have been estimated including those referred for end stage liver disease but not transplanted. Although the perioperative healthcare costs of liver transplantation are high, the long-term costs are acceptable and better than those who were referred but did not undergo liver transplantation.
This research was partially funded by the Capital Health Research Foundation

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