Abstract: SA-OR071
Economic Evaluation of Contemporary Kidney Transplant Practice
Session Information
- Transplant Economics and Live Donor Outcomes
November 04, 2017 | Location: Room 390, Morial Convention Center
Abstract Time: 04:30 PM - 04:42 PM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Axelrod, David A, Lahey Hospital and Clinic, Burlington, Massachusetts, United States
- Irish, William, CTI, Raleigh, North Carolina, United States
- Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States
- Tuttle-newhall, Janet E., St Louis University Center for Outcomes Research, St Louis, Alabama, United States
- Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
- Alhamad, Tarek, Washington University in St. Louis, St. Louis, Missouri, United States
Background
Kidney transplantation (KT) has been established as the optimal therapy for medically suitable patients with end-stage renal disease, prolonging survival and reducing health care spending. However, KT economics using Markov models have assumed compatible donors of average or better quality. The economic implication of KT in contemporary practice including the use of high kidney donor profile index (KPDI) and public health service high risk (PHS) deceased donors, as well transplantation from ABO or HLA incompatible living donors, has not been assessed.
Methods
Using contemporary modeling techniques including Discrete Event Simulation (DES) over a 10-year time horizon, we compared the cost effectiveness of KT from varying donor types and dialysis for patients with kidney failure. DES models were constructed using data drawn from the United States Renal Data System, the national transplant registry, University HealthSystem Consortium, and literature review. Graft failure rates, transplant cost, and disease transmission events were adjusted for donor characteristics.
Results
All KT options resulted in improved patient survival compared to long term dialysis; however, the relative benefits and costs differed substantially (Table). Over a 10 year period, living donor KT with 0-3 HLA mismatches (mm) yielded 77.3 Quality Adjusted Life Months (QALM) at a cost of $53,982 per quality adjusted life year (QALY). By comparison, dialysis provided only 56.4 QALMs at a cost of $110,580 per QALY. HLA incompatible living donor KT was more expensive than dialysis, but resulted in an additional 12 QALM of survival over 10 years. Sensitivity analysis suggests that these results are robust over a clinically relevant range of inputs
Conclusion
KT is cost effective over across a spectrum of donor characteristics, despite higher costs for marginal organs and innovative living donor KT practices.
Economic Evaluation of Renal Replacement Therapy Options
Funding
- Private Foundation Support