07 April 2021

Sweden’s acclaimed research on uterine transplants has taken a new step forward – into the field of health economics. Researchers at Sahlgrenska Academy and Linköping University have for the first time estimated on a scientific basis the cost of the treatment.

pregnant woman.Several uterine transplants from living donors have been carried out in Sweden within the scope of a study. The woman in the photo has no relation to the study. Photo credit xmocb

The current research is based on the nine uterine transplants from living donors carried out in 2013, under the leadership of Mats Brännström, professor of obstetrics and gynaecology at the University of Gothenburg, and chief physician at Sahlgrenska University Hospital.

The transplants were performed within the scope of the world’s first systematic, scientifically based study in the field. After the first birth in Gothenburg in 2014, there were a further seven births, before a woman outside Sweden had a baby after a uterine transplant.

Now that the survey of costs is complete, the results have been reported with certain reservations. First, the number of cases studied is restricted to nine; and, second, the treatment has taken place as part of a research project, subject to the requirements this has entailed. Nonetheless, the study, which has been published in the scientific journal Human Reproduction, gives an initial indication of costs.

The researchers arrived at a total average sum per transplant of EUR 74,564, or approximately SEK 767,000, in current monetary value. This figure comprises costs relating to the recipient and donor alike. The total is described as relatively high, due partly to the extensive scientific requirements. In a future clinical setting, the researchers say, total transplant costs would probably be lower.

“In terms of priorities, this study is important because it contributes key data for deciding whether to offer uterine transplants within publicly funded healthcare. A cost estimate is the starting point for an upcoming assessment of whether the intervention is cost-effective”, says Thomas Davidson, associate professor at the Department of Health, Medicine and Caring Sciences (HMV) at Linköping University.

Cost-effectiveness is usually measured in terms of cost per quality-adjusted life year (QALY) gained — a yardstick that combines economic aspects with longevity and quality of life.

“In assessing cost-effectiveness, we have to relate both costs and effects, preferably measured in QALYs, to those of alternative treatments,” Thomas Davidson says.Lars Sandman.Lars Sandman. Photo credit Charlotte Perhammar

Outstanding issues

“There are still essential issues we want to keep investigating. One is how we should regard the effects of a uterine transplant. Should the QALY gain generated include only the benefit to the mother of getting pregnant, giving birth and being the child’s parent? Or should the benefit of a child being born and living on for a number of years, adding QALYs, be included as well? It makes a big difference in terms of the cost-effectiveness of the intervention, which is an important factor in the priority-setting context”, says Lars Sandman, professor of health care ethics, head of the Centre for Priority Setting in Health Care at Linköping University, and a co-author of the study.Mats Brännström, Professor of Obstetrics and Gynecology at the University of Gothenburg.Mats Brännström, Professor of Obstetrics and Gynaecology at the University of Gothenburg

“All the costs of investigation, staff, and hospital care were funded through research grants. The grand total is close to what we’d calculated, and comparable to the current cost of kidney transplantation from a living donor. In all probability, future uterine transplantation will be more cost-effective thanks to the robot-assisted surgical technique we’ve developed, which means shorter hospital stays and patients returning to work sooner”, says Professor Mats Brännström from the University of Gothenburg.

The study has received funding from the Jane and Dan Olsson Foundations, the Knut and Alice Wallenberg Foundation, the ALF Agreement, and the Swedish Research Council.

The article:The costs of human uterus transplantation: a study based on the nine cases of the initial Swedish live donor trial”, Thomas Davidson, Jana Ekberg, Lars Sandman and Mats Brännström, (2021), Human Reproduction, Volume 36, Issue 2, February 2021, Pages 358–366, doi: 10.1093/humrep/deaa301

Source: Press release from Gothenburg University


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