Journal article
Economic impacts of ABO incompatible live donor kidney transplantation: A national study of Medicare-insured recipients
American journal of transplantation, Vol.16(5), pp.1465-1473
02/08/2016
DOI: 10.1111/ajt.13616
PMCID: PMC4844838
PMID: 26603690
Abstract
The infrequent use ABO incompatible (ABOi) kidney transplantation in the US may reflect concern about the costs of necessary preconditioning and post-transplant care. Medicare data for 26,500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABOi and 62 A2-incompatilbe (A2i) recipients, were analyzed to assess pre-transplant, transplant episode, and 3 year post-transplant cost impacts. The marginal costs of ABOi and A2i vs. ABO compatible transplant (ABOc) were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc transplantation, patient (93.2% vs 88.15, P=0.0009) and death-censored graft survival (85.4% vs 76.1%, P<0.05) at three years were lower after ABOi but not A2i. The average overall cost of the transplant episode was significantly higher for ABOi ($65,080) compared with A2i ($36,752) and ABOc ($32,039) transplantation (P<.001) excluding organ acquisition. ABOi was independently associated with incrementally higher post-transplant spending (year 1: $25,044, year 2: $10,496, year 3: $7,307; P<0.01). ABOi transplantation provides a clinically effective method to expand access to transplantation. While more expensive, the modest increases in total spending are easily justified by avoiding long term dialysis and its associated morbidity and costs.
Details
- Title: Subtitle
- Economic impacts of ABO incompatible live donor kidney transplantation: A national study of Medicare-insured recipients
- Creators
- David Axelrod - Dartmouth–Hitchcock Medical CenterDorry L. Segev - Johns Hopkins UniversityHuiling Xiao - Saint Louis UniversityMark A. Schnitzler - Saint Louis UniversityDaniel C. Brennan - Washington University in St. LouisVikas R. Dharnidharka - Washington University in St. LouisBabak Orandi - Johns Hopkins UniversityAbhijit S. Naik - University of MichiganHenry Randall - Saint Louis UniversityJanet E. Tuttle-Newhall - East Carolina UniversityKrista L. Lentine - University of Michigan
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.16(5), pp.1465-1473
- DOI
- 10.1111/ajt.13616
- PMID
- 26603690
- PMCID
- PMC4844838
- NLM abbreviation
- Am J Transplant
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health; DOI: 10.13039/100000062, name: National Institute of Diabetes and Digestive and Kidney Diseases, award: R01DK102981, R01DK098431
- Language
- English
- Date published
- 02/08/2016
- Academic Unit
- Surgery
- Record Identifier
- 9984322795702771
Metrics
31 Record Views