A study of the quality of life and cost-utility of renal transplantation

Abstract

The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after renal transplantation at three University-based Canadian hospitals. A total of 168 patients were followed for an average of 19.5 months after transplantation. Health-related quality of life was assessed using a hemodialysis questionnaire, a transplant questionnaire, the Sickness Impact Profile, and the Time Trade-Off Technique. Fully allocated costs were determined by prospectively recording resource use in all patients. A societal perspective was taken. By six months after transplantation, the mean health-related quality of life scores of almost all measures had improved compared to pre-transplantation, and they stayed improved throughout the two years of follow up. The mean time trade-off score was 0.57 pre-transplant and 0.70 two years after transplantation. The proportion of individuals employed increased from 30% before transplantation to 45% two years after transplantation. Employment prior to transplantation [relative risk (RR) = 23], graft function (RR 10) and age (RR 1.6 for every decrease in age by one decade), independently predicted employment status after transplantation. The cost of pre-transplant care ($66,782 Can 1994) and the cost of the first year after transplantation ($66,290) were similar. Transplantation was considerably less expensive during the second year after transplantation ($27,875). Over the two years, transplantation was both more effective and less costly than dialysis. This was true for all subgroups of patients examined, including patients older than 60 and diabetics. We conclude that renal transplantation was more effective and less costly than dialysis in all subgroups of patients examined.

HLA-DR and -DQ Eplet Mismatches and Transplant Glomerulopathy: A Nested Case–Control Study

“…2 The number of HLA-DQ eplet mismatches was determined using HLAMatchmaker from amino acid chains coded by HLA-DQA1 and HLA-DQB1 alleles. 3 Serologic equivalents of HLA-DRB1 chains were considered to quantify HLA-DR antigen mismatches. 4 The number of HLA-DR eplet mismatches was determined using HLAMatchmaker from amino acid chains coded by HLA-DRB1 and HLADRB3/4/5 alleles.…”

The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation

“…For eligible candidates, transplantation is considered the optimal treatment given that it is far less resource-intensive and associated with improved survival and higher quality of life compared with dialysis (1,2). Although the prevalence of ESRD is increasing in Canada, the United States, and the world (3), transplantation rates have not kept pace (4,5), and new strategies to increase donation are urgently needed.…”

Dialysis, Kidney Transplantation, or Pancreas Transplantation for Patients with Diabetes Mellitus and Renal Failure

“…They may remain on dialysis or undergo cadaveric kidney transplantation (CKT), living kidney transplantation (LKT), simultaneous pancreas-kidney transplantation (SPKT), or pancreas transplantation after living kidney transplantation (PAKT) (2,3). Renal transplantation offers an improvement in long-term survival and quality of life when compared with dialysis (4,5). A functioning pancreas transplant results in normal or near-normal blood glucose levels and independence from exogenous insulin (2,6); this leads to an improvement in health-related quality of life, as there is no need for daily insulin injections, frequent glucose monitoring, or a strict diet (7,8).…”