ArticleEinstein (Sao Paulo, Brazil)2025
Use of propensity score matching to reduce bias in economic evaluations in the context of Brazilian liver transplantation.
Article in Einstein (Sao Paulo, Brazil), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo estimate the incremental cost and survival of patients on the liver transplantation waiting list who were referred for transplantation.
methodsWe analyzed a cohort of 883 patients who underwent liver transplantation within the Support Program for the Institutional Development of the Unified Health System in Brazil between 2010 and 2022. Median survival was assessed using the Kaplan-Meier method and parametric extrapolation of the survival curve. A bottom-up micro-costing approach was used to direct medical hospital costs. We conducted an economic evaluation comparing patients who received transplant with those who were listed to assess the potential of propensity score matching in reducing bias in this context.
resultsThe economic evaluation revealed a median survival of 15.54 and 1.07 years and a mean cost of US$ purchasing power parity of 162,821.96 and 39,044.79 for patients who received transplant and listed patients, respectively. A reduction in survival and an increase in mean costs for the listed patients were observed following propensity score matching.
conclusionA direct comparison of survival and costs between the two patient groups may lead to biased estimates of the incremental survival or costs associated with referring a patient for a liver transplantation procedure. Propensity score matching reduces the bias from differences in health status between these two patient groups, enabling more accurate estimates of the incremental survival and cost associated with referring a patient for transplantation.
backgroundAnazawa et al. show that matching methodologies are beneficial in health economic evaluations to reduce the bias originating from sample selection. The cost-effectiveness of the liver transplantation procedure improved after sample balancing.
background■ Matching methodologies may reduce bias in economic evaluations.
background■ Liver transplantation within the Proadi-SUS context has an incremental cost-effectiveness ratio below the Health Technology Incorporation in the Brazilian Health System threshold.
background■ The patients who received transplant had a median survival of 10.1 years after list enrollment.
background■ The mean cost per transplanted patient was US$ PPP 162,821.96.
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