Using simulation for the economic evaluation of liver transplantation

This paper demonstrates the use of simulation in an evaluative study for the technology of liver transplantation from the cost-effectiveness point of view. This study is conducted in the United Kingdom where there are no explicit guidelines for the prioritization of patients waiting for transplantation. Another objective of the model is to enable health economists to understand the technology of liver transplantation and evaluate alternative policies for prioritizing patients in the waiting list. The paper shows the construction of a tailor-made package (LiverSim) and provides an example of how this package is used by the stakeholders to assist in the evaluation process. Some final lessons are drawn that simulation helps in exploring more issues outside the boundaries of quantitative results.

[1]  Mark S. Roberts,et al.  Markov process-based Monte Carlo simulation: a tool for modeling complex disease and its application to the timing of liver transplantation , 1992, WSC '92.

[2]  Diane Sears,et al.  Life-and-death decisions. , 1985, The Washington post.

[3]  Ray J. Paul,et al.  Simulation modeling as an aid to decision-making in healthcare management: the adjuvant breast cancer (ABC) trial , 1999, WSC '99.

[4]  J Neuberger,et al.  Allocating donor livers , 1997, BMJ.

[5]  J. Neuberger,et al.  Liver transplantation for alcoholic liver disease: Evaluation of a selection protocol , 1997, Hepatology.

[6]  R Williams,et al.  Selection for transplantation. , 1993, Journal of hepatology.

[7]  S. Vera,et al.  Socioeconomic aspects of hepatic transplantation. , 1987, The American journal of gastroenterology.

[8]  T E Starzl.  Liver Transplantation: Practice and Management , 1994 .

[9]  R. Calne,et al.  Liver transplantation: Practice and Management , 1994 .

[10]  P. Grambsch,et al.  Prognosis in primary biliary cirrhosis: Model for decision making , 1989, Hepatology.

[11]  O. Jonasson,et al.  Waiting in line: should selected patients ever be moved up? , 1989, Transplantation proceedings.

[12]  S J Pocock,et al.  Prediction of short-term survival with an application in primary biliary cirrhosis. , 1992, Statistics in medicine.

[13]  C. Pritchard,et al.  Raf revealed in life-or-death decisions , 1997, Nature Genetics.

[14]  Bertrand Dousset,et al.  The improved results of liver transplantation , 1992, Transplant international : official journal of the European Society for Organ Transplantation.