8 PHARMACOECONOMICS

Retransplantation is not cost-effective Retransplantation is a cost-ineffective use of

limited donor organs, suggests an analysis of the comparative costs of kidney, liver and heart retransplantation in the US. Patients who might benefit from primary transplantation are denied the opportunity and society must bear the excessive expense arising from ineffective transplant procedures.

Charges for retransplantation are greater than those associated with primary grafts. While this difference is relatively small for kidney transplants, it increases for heart and liver transplants [see figure].

Comparative charges for transplant procedures

o so 100 1 so 200 250 300 350

Thousand, 01 doll.,. (SUS)

The outcome after retransplantation is less favourable, as reflected by the significant differences in I-year patient survival following primary grafts and retransplantation in liver and heart allograft recipients (69 vs 50% and 83 vs 61 %, respectively). While I-year patient survival among kidney graft recipients is similar for both procedures, graft survival is > 9% lower after retransplantation.

The study authors believe careful patient selection provides the 'most realistic approach' to increase the cost-utility for all transplantation procedures. Evans RW, Manninen DL, Dong FB, McLynne DA. Is retransplantation cost effective? Transplantation Proceedings 25: 1694-1696, Part 2, Feb 1993

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20 Mar 1993 INPHARMA'" ISSN 0156-2703/93/0320-008/$1.00~ Adls Intarnatlonal Ltd