Intestinal Transplantation is Cost Effective in the Treatment of Complicated Intestinal Failure

Abstract

Introduction: When life-threatening complications occur due to home parenteral nutrition (HPN), intestinal transplantation (ITx) is indicated. ITx is the most expensive solid organ transplant but the true cost effectiveness is unknown. Aim: To compare the costs of complicated HPN before ITx to the costs after ITx at our institution. Methods: We performed a retrospective analysis of our cohort of ITx patients, transplanted between 1/1/2000 and 31/12/2015. Total costs analyzed included all costs for surgery, admissions, diagnostics, treatments, outpatient clinics and medication. For those patients followed at our center pre-ITx, the costs before ITx, including the HPN care were included up to 2 years before surgery. All costs for pre-transplant screening were excluded from the pre-transplant data. Results: 16 patients (12 adults (7 females, mean age 43 years (23–57)) and 4 children (1 female, mean age 8 years (range: 3–17))), were included in this study. 15 patients underwent ITx while 1 patient was listed for ITx at time of analysis. 8 patients were followed at our center pre-ITx and financial data were therefore available. The causes of intestinal failure for the adults were short bowel syndrome (SBS) (67%), diffuse portomesenteric thrombosis (25%) and chronic intestinal pseudo-obstruction (8%). 2 children had SBS after volvulus and 2 children had congenital mucosal diseases. All patients were listed for ITx due to severe complications from HPN or the underlying disease. 7 patients underwent isolated ITx, 5 had a combined Liver-ITx and 3 underwent multivisceral transplantation. The 5-year patient survival was 86.7%. The median costs in year −2 (day 720 – 366 pre-ITx) was € 90 891 (60 682–342 299) and year – 1 (day 365–1 pre-ITx) was € 134 006 (83 854 - € 275 712). After ITx, the costs of the first year were € 185 662 (122 483–571 301). In year 2, there was a 76% reduction in overall costs to € 44 893 (3 905–293 985) due to a reduction of hospitalizations. In year 1, the patients were hospitalized for a median of 145 days (78–365) while in year 2, this had dropped to 37 days (0–319). In adult patients, the costs drop much faster while remaining quite high until year 3 in children.FigureConclusion: Intestinal transplantation, while being an expensive procedure, was cost effective in adults by the second year. In children, ITx was cost effective from the third year onward, because of more complicated treatment of underlying congenital disease.