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An economic assessment of contemporary kidney transplant practice
Journal article   Open access   Peer reviewed

An economic assessment of contemporary kidney transplant practice

David A Axelrod, Mark A Schnitzler, Huiling Xiao, William Irish, Elizabeth Tuttle‐Newhall, Su‐Hsin Chang, Bertram L Kasiske, Tarek Alhamad and Krista L Lentine
American journal of transplantation, Vol.18(5), pp.1168-1176
05/2018
DOI: 10.1111/ajt.14702
PMID: 29451350
url
https://doi.org/10.1111/ajt.14702View
Published (Version of record) Open Access

Abstract

Kidney transplantation is the optimal therapy for end‐stage renal disease, prolonging survival and reducing spending. Prior economic analyses of kidney transplantation, using Markov models, have generally assumed compatible, low‐risk donors. The economic implications of transplantation with high Kidney Donor Profile Index (KDPI) deceased donors, ABO incompatible living donors, and HLA incompatible living donors have not been assessed. The costs of transplantation and dialysis were compared with the use of discrete event simulation over a 10‐year period, with data from the United States Renal Data System, University HealthSystem Consortium, and literature review. Graft failure rates and expenditures were adjusted for donor characteristics. All transplantation options were associated with improved survival compared with dialysis (transplantation: 5.20‐6.34 quality‐adjusted life‐years [QALYs] vs dialysis: 4.03 QALYs). Living donor and low‐KDPI deceased donor transplantations were cost‐saving compared with dialysis, while transplantations using high‐KDPI deceased donor, ABO‐incompatible or HLA‐incompatible living donors were cost‐effective (<$100 000 per QALY). Predicted costs per QALY range from $39 939 for HLA‐compatible living donor transplantation to $80 486 for HLA‐incompatible donors compared with $72 476 for dialysis. In conclusion, kidney transplantation is cost‐effective across all donor types despite higher costs for marginal organs and innovative living donor practices. Kidney transplant in contemporary practice remains cost‐effective despite a higher cost of transplant associated with donor quality and immunologic complexity. See Jay and Abecassis's editorial on page 1044.
 economics organ transplantation kidney transplantation/nephrology simulation cost‐effectiveness business/management health services and outcomes research kidney transplantation/living donor

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