RETHINKING ECONOMIC MODELING IN ORGAN TRANSPLANTATION: A NEW CONCEPTUAL MODEL FOR COST-EFFECTIVENESS ANALYSIS
Author(s)
Pauline Breuer, MSc1, Esther de Bekker-Grob, PhD1, Olivier Manintveld, MD, PhD2, Liset Pengel, PhD3, Jan IJzermans, MD, PhD3, Lucas Goossens, PhD1.
1Erasmus School of Health Policy and Management, Rotterdam, Netherlands, 2Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 3Erasmus MC Transplant Institute, Rotterdam, Netherlands.
1Erasmus School of Health Policy and Management, Rotterdam, Netherlands, 2Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands, 3Erasmus MC Transplant Institute, Rotterdam, Netherlands.
OBJECTIVES: Organ transplantation improves survival and quality of life, but concerns regarding organ availability and rising healthcare costs underscore the need for value-based strategies. However, current economic models often fail to capture the constrained and dynamic nature of transplantation. Assessing cost-effectiveness therefore requires a tailored modelling approach accounting for these supply shifts. We aimed to develop and validate a conceptual framework for economic evaluations of transplant interventions.
METHODS: We developed a conceptual model for economic evaluations of transplant technologies. Using identified mechanisms and modelling practices from a prior scoping review, we constructed a model including clinical events, health states, costs, and outcomes. The model was refined and validated through a four-round online Delphi study (Qualtrics) with 19 multidisciplinary transplant clinicians—experts in kidney, liver, pancreas, heart, and lung transplantation—from ten European Society of Organ Transplantation member countries, recruited via relevant professional networks and transplant associations.
RESULTS: Key patient populations, mechanisms, and data sources were identified in line with ISPOR Task Force recommendations and CHEERS guidelines. Delphi results specified an eight-state model structure incorporating pre-transplant states, preparation, transplantation, post-transplant, and re-transplantation phases. Within the post-transplant state, six sub-states were defined to capture interventions and complications affecting patient outcomes. The structure accommodates interventions targeting not only the transplant procedure itself, but also pre-transplant factors (e.g. pre-habilitation programs), organ availability (e.g. machine perfusion), and post-transplant interventions (e.g. immunosuppressive therapy and complication management). Key modelling considerations were identified, including cycle lengths, transplant timing, and assumptions on recovery such as return-to-work.
CONCLUSIONS: We developed a conceptual model that provides a structured basis for future decision-analytic models assessing cost-effectiveness in transplantation. It can support reimbursement and clinical decisions by highlighting interventions with potential value. Future work should apply this framework in real-world cost-effectiveness analyses to further assess its adaptability across organ types and interventions.
METHODS: We developed a conceptual model for economic evaluations of transplant technologies. Using identified mechanisms and modelling practices from a prior scoping review, we constructed a model including clinical events, health states, costs, and outcomes. The model was refined and validated through a four-round online Delphi study (Qualtrics) with 19 multidisciplinary transplant clinicians—experts in kidney, liver, pancreas, heart, and lung transplantation—from ten European Society of Organ Transplantation member countries, recruited via relevant professional networks and transplant associations.
RESULTS: Key patient populations, mechanisms, and data sources were identified in line with ISPOR Task Force recommendations and CHEERS guidelines. Delphi results specified an eight-state model structure incorporating pre-transplant states, preparation, transplantation, post-transplant, and re-transplantation phases. Within the post-transplant state, six sub-states were defined to capture interventions and complications affecting patient outcomes. The structure accommodates interventions targeting not only the transplant procedure itself, but also pre-transplant factors (e.g. pre-habilitation programs), organ availability (e.g. machine perfusion), and post-transplant interventions (e.g. immunosuppressive therapy and complication management). Key modelling considerations were identified, including cycle lengths, transplant timing, and assumptions on recovery such as return-to-work.
CONCLUSIONS: We developed a conceptual model that provides a structured basis for future decision-analytic models assessing cost-effectiveness in transplantation. It can support reimbursement and clinical decisions by highlighting interventions with potential value. Future work should apply this framework in real-world cost-effectiveness analyses to further assess its adaptability across organ types and interventions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA11
Topic
Economic Evaluation, Health Technology Assessment