Cost-Utility and Budget Impact Analyses of Including Liver Transplantation in Children into the Universal Health Coverage Benefit Package of Thailand

Liver transplantation in children is an expensive health service excluded from the benefit package of the universal coverage (UC) scheme of Thailand. Its high costs and exclusion from the UC benefit package prevent poor biliary atresia (BA) patients from access to such expensive health care. This study aims to estimate budget requirement for including liver transplantation in children into the UC benefit package. It also explores demand for and supply of liver transplantation, and financial feasibility in implementing universal access to such expensive health care in Thailand. Research methods include comprehensive literature review, in-depth interviews of medical specialists in three university hospitals about incurred costs during and after liver transplantation, and modeling budget requirements for expanding universal access to such medical care.Research findings indicate that the incidence of BA patients in Thailand is approximately 1 to 15,000 of live births, or around 60-80 new cases of BA patient annually. Only three university hospitals in Thailand can provide liver transplantation to children with the maximum surgical capacity of 40 cases per year. Literature shows the survival rate of BA children receiving liver transplantation ranges from 83% to 94% in the first year, and from 82% to 92% in the fifth year. Costs of liver transplantation in the first year are approximately 1 million Baht (~US$ 30,000). Other costs after the first year including immunosuppressive drugs and prophylaxis antibiotics range from 12,000-20,000 Baht per month. When the discount rate of 3% for the following years is applied, the government will spend approximately 40 million Baht in the first year of implementation. The financial burden will increase to 137 and 201-202 million Baht per year in the year 30th and 70th, respectively. QALYs gained increased from approximately 0.526 in pre-transplantation to be 0.706 and 0.695 in the 1st and 2 nd year of post-transplantation, respectively. The budget requirement for this medical care is trivial (0.04%) compared to the total UC budget, but can save lives of BA patients and significantly improve equity in access to health care