WWTMHJW@heitue5.bitnet (01/11/89)
Distribution-File:
ageing@irlearn !BIOSCI Ageing Bulletin Board
epid-l@qucdn !Topics in Epidemiology and Statistics
!famcomm@rpicicge !Marital/Family & Relational Communication
gerinet@ubvm !Prototype Geriatric Health Care Communication
health-l@irlearn !International Discussion on Health Research
!healthco@rpicicge !Communication in Health/Medical Context
medinf-l@dearn !Medical Informatics discussion list
radsig@uwavm !Radiology Special Interest Group
support@rpicicge !Moderators for famcomm and healthco
In the "Science & Education" section of the Nieuwe Rotterdamse Courant (Nether-
lands) of 1989-01-10, an article has appeared entitled "Is liver transplanta-
tion too expensive for the Netherlands?". It describes (what is claimed to be)
the first Technology Assessment on Liver Transplantation ever published;
authors are the group of Prof.dr. J.D.F. Habbema, recently appointed to the
chair of Medical Decision Making at the Faculty of Medicine, Erasmus University
Rotterdam/NL.
The study (currently in Dutch only) consists of a final report and six special
reports, focusing on experiences at Groningen University/NL where financing of
liver transplantation has been guaranteed for three more years.
According to the Habbema-report, a liver transplantation costs on average about
H.Fl. 250,000 (1 US $ = H.Fl. 2,10), to be split up as: liver acquisition
H.Fl. 13,500; surgery H.Fl. 15,350; re-interventions H.Fl. 9,800; 174 hospita-
lization days (totalling 5 years) H.Fl. 94,000; medication (especially cyclo-
sporine) H.Fl. 85,400, and "other expenses". These expenses can be covered
under public and private health insurance, but no guarantees are currently
available.
Major conclusions of the report are: on average, short-time survival expectancy
is low, as most deaths occur within one year. However, those surviving more
than one year (in most centers approximately 80% of all operated patients) have
a good change of surviving more than 5 years. Too early surgery is not recom-
mended, as this may unnecessarily shorten the patient's life.
Considerable attention is devoted to "quality of life" issues, based on compu-
terized interviews of 36 patients; however, another (Groningen) study on 31
patients (24 females, 7 males) provides a clearer picture (Liver transplants:
psycho-social aspects, by Heyink, Roorda & Tijmstra, Section for Health Sciences
at Groningen University's Faculty of Medicine, 1988, in Dutch).
In the same journal issue, an interview was published with Dr R.A.F. Krom, one
of the first members of the Groningen team. He obtained his education with Dr
Starzl in Pittsburg/PA, and performed the first 36 liver transplants in Groning-
en. He then went to the Mayo Clinic in Rochester/MN in order to set up a liver
transplant clinic; currently, about 375 transplants have been performed at Mayo,
where a guarantee must be provided by the patient in the order of US $ 170,000
(health insurer, private sources, and sometimes the relevant state's "emergen-
cy fund"). In the USA, liver transplantation is fully accepted, with about 15
centers performing 15 - 20 transplants per year on average (the Pittsburg cen-
ter does about 500 per year, and the Mayo Clinic more than 50 per year).
According to Dr Krom, the Netherlands would need two centers capable of con-
ducting 100 transplants per year in total.
H.J. Woltring, Research Associate
Biomedical & Health Technology
Eindhoven University of Technology
Eindhoven, The Netherlands