An economic assessment of contemporary kidney transplant practice

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.

Desensitization strategies: is it worth it?

“…While desensitization treatments increase the cost of transplant, the overall economic impact needs to be considered in light of longer survival and a reduced need for haemodialysis. The cost‐effectiveness of incompatible living donor transplant was assessed using a discrete event simulation model . Over 10 years, incompatible living donor kidney transplant was associated with a greater mean cost of care ($440 234 vs. $292 117) and longer mean survival (5.47 years vs. 4.03).…”

Evaluation and care of international living kidney donor candidates: Strategies for addressing common considerations and challenges

“…Living donor kidney transplantation (LDKT) is the best treatment for most patients with end-stage kidney disease (ESKD), conferring improved length and quality of life compared to dialysis or deceased donor kidney transplantation (DDKT), at lower costs to the healthcare system. [1][2][3] While 2018 marked the first substantial increase in living donation in more than a decade, [4][5][6] there is still a need for monitoring and attention to barriers and disincentives to donation and LDKT. 7,8 Further, racial disparities in LDKT in the United States have heightened over time.…”

Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden

“… Disclosures/Conflicts of Interest: The authors are volunteer members of the American Society of Transplantation Living Donor Community of Practice (LDCOP). Rebecca Hays, MSW, APSW 2 consults for Novartis on living donation. The terms of this arrangement have been reviewed for objectivity in research and presentation.…”

“…Rebecca Hays, MSW, APSW 2 consults for Novartis on living donation. The terms of this arrangement have been reviewed for objectivity in research and presentation.…”