Addition of adult‐to‐adult living donation to liver transplant programs improves survival but at an increased cost

Using outcomes data from the Adult‐to‐Adult Living Donor Liver Transplantation Cohort Study, we performed a cost‐effectiveness analysis exploring the costs and benefits of living donor liver transplantation (LDLT). A multistage Markov decision analysis model was developed with treatment, including medical management only (strategy 1), waiting list with possible deceased donor liver transplantation (DDLT; strategy 2), and waiting list with possible LDLT or DDLT (strategy 3) over 10 years. Decompensated cirrhosis with medical management offered survival of 2.0 quality‐adjusted life years (QALYs) while costing an average of $65,068, waiting list with possible DDLT offered 4.4‐QALY survival and a mean cost of $151,613, and waiting list with possible DDLT or LDLT offered 4.9‐QALY survival and a mean cost of $208,149. Strategy 2 had an incremental cost‐effectiveness ratio (ICER) of $35,976 over strategy 1, whereas strategy 3 produced an ICER of $106,788 over strategy 2. On average, strategy 3 cost $47,693 more per QALY than strategy 1. Both DDLT and LDLT were cost‐effective compared to medical management of cirrhosis over our 10‐year study period. The addition of LDLT to a standard waiting list DDLT program is effective at improving recipient survival and preventing waiting list deaths but at a greater cost. Liver Transpl 15:148–162, 2009. © 2009 AASLD.