Cost-utility analysis of normothermic liver perfusion with the OrganOx compared to static cold storage in the United Kingdom.

Background: Rising numbers of patients on the liver transplant waiting list has led to the utilization of organs from higher-risk donors that are more likely to be discarded and are prone to post-transplant complications. Storage and transportation of these livers at low temperatures can cause damage. OrganOx is a portable device intended to preserve and maintain the donated liver in normothermic conditions for up to 24 h prior to transplantation.

Objective: To evaluate the cost-utility of normothermic machine perfusion with OrganOx in liver transplantation compared to the current practice of static cold storage (SCS).

Methods: A de novo decision analytic model (a decision tree along with a Markov model), based on current treatment pathways, was developed to estimate the costs and outcomes. Results from a randomized clinical trial and national standard sources were used to inform the model. Costs were estimated from the National Health Service and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSA) were conducted to explore uncertainty surrounding input parameters.

Results: Over a lifetime time horizon, liver transplantation with OrganOx was more costly and more effective than the current practice of static cold storage. The total costs per patient were £37,370 vs £46,711, and the total effectiveness per patient was 9.09 QALYs vs 10.27 QALYs for SCS and OrganOx groups, respectively. The estimated ICER was £7,876 per each QALY gained. Results from the PSA showed that use of OrganOx has 99% probability of being cost-effective at a £20,000 willingness-to-pay threshold. OrganOx led to the utilization of 54 additional livers with patients experiencing lower rates of early allograft dysfunction and adverse events.

Conclusions: Use of OrganOx for the perfusion and transportation of livers prior to transplantation is a cost-effective strategy. KEY POINTS FOR DECISION MAKERS Introduction of OrganOx into NHS could increase the utilisation of donated livers with patients experiencing lower rates of early allograft dysfunction and adverse events, compared with current practice. Results of the economic analysis indicate that the OrganOx is highly likely to be cost-effective and result in improved patient outcomes.