Economic evaluation of ex-vivo lung perfusion for lung transplantation: A cost-utility analysis from a large Canadian center

Background Ex-vivo lung perfusion (EVLP) enables evaluation and rehabilitation of potentially-useable donor lungs outside the body prior to transplantation. However, its health economic implications are unclear. We sought to determine the cost-utility of adding EVLP to the Toronto Lung Transplant Program. Methods We performed a cost-utility analysis, from the hospital perspective, using an individual-level simulation with a lifetime time horizon. We considered adults with end-stage lung disease waitlisted for first lung transplantation in Ontario, Canada from 2005 to 2019. We compared a situation in which all donor lungs were conventionally preserved (No-EVLP) versus a situation with conventionally-preserved lungs plus EVLP-treated qualifying donor lungs (EVLP available). We estimated lifetime costs (2019 CAD), health outcomes, and quality-adjusted life years (QALYs), discounted at 1.5% annually; results were summarized as incremental net monetary benefit (iNMB). Results EVLP-availability yielded shorter waitlist duration (101 [95% credible interval CI 79–125] days versus 258 [95% CI 222–294] days; p'0.001) and reduced waitlist mortality (9.1% [95%CI 7.3–11%] versus 19.3% [95%CI 17.1–21.8%]; p'0.001). Having EVLP available resulted in lower cumulative costs ($273,827 [95%CI $248,190–$299,654] versus $308,790 [95%CI $271,836–$342,431]; p'0.001), with higher QALY (4.72 [95%CI 3.75–5.26] QALY versus 4 [95%CI 3.07–4.59] QALY; p'0.001). At a cost-effectiveness threshold of $50,000 per QALY, we estimated an iNMB of $70,987 (95%CI $57,721–$76,414); EVLP was considered cost-effective at all thresholds evaluated between $0 and $100,000 per QALY. Conclusions The benefits of having EVLP available at our center outweighed its costs; investment in EVLP is economically justifiable. TWITTER / X POST In economic evaluation, the benefits of having ex-vivo lung perfusion for lung transplantation outweighed its costs. EVLP was cost-effective at all thresholds, with higher QALYs and lower cumulative costs.