Intestinal Transplantation is Less Expensive Compared to Long-Term Home Parenteral Nutrition in Adults.

Abstract

Introduction: The primary treatment of intestinal failure is home parenteral nutrition (HPN) while intestinal transplantation (ITx) is reserved for those cases where severe complications occur. In renal failure, transplantation has been promoted over dialysis because transplantation reduces the costs. It is unknown whether ITx is cost effective in the treatment of chronic intestinal failure. Aim: To compare the costs of uncomplicated HPN patients to a cohort of ITx patients at our institution. Methods: First, we collected the cost data from our adult cohort of stable, long-term (>2 years) HPN patients. We included all patients with minimum of 5 years follow-up. The first two years after start of HPN were excluded in order to identify the actual cost of stable intestinal failure patients. Second, we analyzed our cohort of ITx patients, transplanted between 1/1/2000 and 31/12/2015. We collected all costs from day 1 until 5 years post-transplant. Next, we compared the costs between stable HPN patients and ITx in these 5 years-period. All costs were rounded to the nearest euro and corrected for inflation to 2015. Results: There were 28 HPN patients in this cohort, (14 females, mean age 58.6 years). Median duration of HPN was 8.6 years (5.1-12.0). HPN was administered 4.1 days per week (range: 1.5-7) at 5767 total kcal (2385-10890). Indications were short bowel syndrome (SBS) (57%), intestinal dysmotility (24%), mechanical obstructions (14%) and mucosal disease (5%). There were 12 patients transplanted in this study period. The main causes of intestinal failure were SBS (67%) and diffuse portomesenteric thrombosis (20%). Indication for ITx were life-threatening complications from HPN or underlying disease. The 5-year patient survival was 83.3%. For HPN patients, the total annual costs remained quite stable at a median of € 59 524 (58 731-65 807). HPN costs (basic costs and treatment of complications) accounted for 76% of these costs. After ITx, the first year costs were € 172 133 (122 483-351 407) which then drops to € 8 832 (3 270-38 723) in year 5 (Figure 1).FigureConclusions: ITx has a high initial cost compared to stable, adult HPN patients. From year 2 onwards, ITx patients cost less than stable HPN patients. By year 4, the additional costs incurred in year 1 of ITx are recovered making the procedure cost effective.