Budget Impact Analysis of Including Liver Transplantation in Children into the Universal 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, which covers 47 million of Thais. Its high costs and exclusion from the UC benefit package prevent poor biliary atresia (BA) patients from access to such health care. This study aims to estimate financial impact of including liver transplantation in children in the UC benefit package. It also explores demand for and supply of, and financial feasibility in implementing universal access to such expensive health care in Thailand. Methods include comprehensive literature review, in-depth interviews of medical specialists in liver transplantation in three university hospitals about incurred costs during and after operations, 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, approximately 60 new cases of BA patient annually. Only three university hospitals in Thailand can provide liver transplantation to children with the annual maximum surgical capacity of 40 cases. Literature shows the survival rate of BA children receiving liver transplantation ranges from 83% to 94% in the first year, and 82% to 92% in the fifth year. Costs of liver transplantation in the first year are approximately 1 million Baht (~ 30,000 USD). Other costs after the first year including immunosuppressive drugs and prophylaxis antibiotics range from 360-600 USD per month. The government will spend approximately 40 million Baht in the first year of implementation. The financial burden will increase to 184 and 328 million Baht per year in the year 30th and 70th, respectively. The budget requirement for this medical care is trivial compared to the total UC budget, but can save lives of BA patients and improve equity in access to health care