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Kidney Week

Abstract: PO1967

The Cost-Effectiveness of Blood Product Irradiation in Pediatric Hemodialysis Patients Awaiting Kidney Transplant

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Author

  • Merrill, Kyle, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Pediatric patients diagnosed with end-stage kidney disease often initiate hemodialysis prior to kidney transplantation. Development of anti-HLA antibodies reduces the organ pool for that patient. Blood products are one known cause of allosensitization, or the development of anti-HLA antibodies. Gamma-irradiation of blood products may decrease this possibility. Patients with less anti-HLA antibodies have higher rates of kidney transplantation. Therefore, a cost-effectiveness analysis of whether to irradite blood products for hemodialysis patients and the chance of successful kidney transplantation was performed.

Methods

A Markov model was utilized in this analysis. The model started with the choice to irradiate blood or not prior to entering the Markov. To simplify the model, it was assumed that transfusion with a non-irradiated blood product will result in a cPRA of 30% and irradiation decreased this to 10%. Patients only received one blood product exposure. After kidney transplant, it was asusmed there was no graft failure and return to dialysis. Mortality rates were calculated based on age-specific mortality tables along with the annual excess mortality for each state of the patient.

Results

The irradiate strategy dominates in the base case and is both cheaper at $985,749 (versus $1,049,614) and more effective at 13.00 quality adjusted life years (versus 12.81) when compared to the choice of non-irradiation. A one-way sensitivity analysis was completed on the relative transplant rate and showed that a rate of 1.0006x was the breakpoint where irradiate dominates non-irradiate. A one-way analysis on the cost of blood product irradiation found that even if irradiation costed 100x the base case, it was still the dominating chioce. The last one-way sensitivity analysis noted that as the monthly cost increased from $0 to $10,000 per month, that until the monthly cost was around $3,700, then the more cost-effective choice was to not irradiate, but at any cost higher than $3,750, then the choice to irradiate dominate non-irradiation.

Conclusion

Blood product irradiation was found to be more cost effective. Even with a slight increase in transplant rate, irradiate remained the more cost-effective choice. The cost of irradiation does not affect the choice to irradiate but if hemodialysis were cheaper, the choice to not irradiate was more cost-effective.