The liver transplantation programme of the University Hospital of Groningen, the Netherlands, was evaluated on behalf of the Dutch Sick Fund Council. From 1978 to 1987 561 patients were put forward for liver transplantation (LTX). During this period, 76 orthotopic liver transplants were carried out, 8 of which were retransplantations. Survival proved to depend on, among other things, diagnosis and age. One-year survival was 100% in children with biliary atresia and 60% in other diagnosis and age groups. The number of life-years gained by LTX depends on the stage of disease. After LTX the quality of life improves quickly. One year after LTX most survivors experience a virtually normal quality of life. The need of LTX in the Netherlands was estimated to be in the range of 25 to 69 transplantations on an annual basis. The annual supply of donor livers is expected to be about adequate. Costs amount to approx. Hfl 250,000.--per transplanted patient including costs of follow-up for up to five years. The cost-effectiveness ratio for all forms of cirrhosis was estimated at Hfl 47,000.--to 133,000.--per life year gained. The results of this first technology assessment on liver transplantation proved relevant for clinicians as well as health politicians.
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