O-17 Are macroeconomic and health expenditure indicators correlated with the capacity for liver transplantation in Latin American Countries? THE ALEH Special Interest Group, international Survey 2020

Abstract

Introduction: Latin America (LA), is a geographical region with 20 countries homing 652 million people (10% world population), with a huge cultural, economic and developmental diversity. The ALEH (Asociación Latinamericana para el Estudio del Hígado) has driven the formation of special interest groups (SIGs) to enhance the collaboration of health care professionals with common specialized interests in the field of hepatology. The gross domestic product (GDP) is a monetary measure of the market value of all the final goods and services produced in a specific time period by a country. The ratio of GDP to the total population of the region is the per capita GDP (Mean Standard of Living). It is often considered to be the ''world's most powerful statistical indicator of national development and progress''. On the other hand, Liver transplantation (LT) is considered a very expensive procedure requiring high-cost management with a lifelong immunosuppression, hence a possible barrier to some underdeveloped countries. In the different regions of the USA, there has been shown a strong correlation between GDP per capita and all organ donation rates, except heart donation (1988-2012). In LA countries, there is almost no data on the relation of macroeconomic indicators in relation to the capacity for LT. Aims: To study the influence of macroeconomic indicators with the LT capacity in LA. Methods: During 2020, LA countries, were invited to nominate representatives to this SIG and also from the STALYC. Online ZOOM meetings were arranged to discuss a survey of more than 70 questions in relation to different topics in LT including economic indicators of countries, barriers and access to LT. A database with all the information was built in an excel file. Scatter plot graphs were built to evaluate correlation and linear regression equations for different variables. Results: 15 out of 20 countries completed the questionnaire by Jan/2021. During 2019 there were 3,354 DDLT performed in 13 out of the 15 countries (DDLT rate of 5.85 LT/pmp), and 483 LDLT in 7 countries. The mean costs of LT (hospitalization and first month) in our survey was 57,000 USD. After evaluating a few macroeconomic indicators, the higher GDP per capita and the higher health expenditure (as % of GDP) had a good positive correlation with the LT capacity in LA countries (scatter plot). There was no correlation with the gross GDP with LT (DDLT nor LDLT), nor with de number of active LT centers in each country. Conclusions: Our study shows a positive correlation between economic indicators of prosperity (GDP per capita and health expenditure) and LT rates. Chronic liver diseases are a very common cause of burden of disease in LA, and although LT is a high-cost procedure, it is. a lot less expensive than in other world regions. LA is still composed of countries with huge cultural, economic and developmental diversity and where at least 30% of the population lives in poverty, nevertheless, some countries have been able to perform LT with rates > 5 ppm with excellent results. There is need to improve education and investment in LT as a health priority, being saving life procedure making possible to return a chronic patient to a normal and productive life.