Economic Consequences of Adult Living Kidney Donation: A Systematic Review

Fu, Rui; Sekercioğlu, Nigar; Hishida, Manabu; Coyte, Peter C.

doi:10.1016/j.jval.2020.10.005

Cited by 30 publications

(16 citation statements)

References 34 publications

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“…To allow for comparison across studies, a score of 1 (yes), −1 (no), −0.5 (unclear), or 0 (not applicable) was assigned to these rating options, and a mean score was computed for each study. We deemed studies that scored 80% or above, 60% to 80%, and less than 60% to have low, medium, and high risk of bias, respectively . No studies were excluded on the basis of quality.…”

Section: Methodsmentioning

confidence: 99%

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Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Sykes,

Weisbrod,

Rival

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHead and neck cancers (HNCs) are often diagnosed at advanced clinical stages during their symptomatic phase, leading to a reduced treatment window and poor survival. Screening programs have been suggested as a mitigation strategy.ObjectiveTo examine the effectiveness of current HNC screening programs in improving diagnosis and survival in adults.Evidence ReviewThis Preferred Reporting Items for Systematic Reviews and Meta-analyses–guided systematic review involved use of peer-reviewed, English-language journal articles identified from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between January 1, 2001, and July 15, 2022. Snowballing was applied to retrieve more studies. Eligible articles were original clinical trials and observational studies presenting a universal or risk-targeted screening program of primary HNC in the adult population. Reporting quality was assessed using the JBI’s critical appraisal tools.FindingsDatabase searches yielded 3646 unique citations with an additional 8 studies found via snowballing. Five reviewers assessed the full text of 106 studies. Sixteen articles were ultimately included in the review, involving 4.7 million adults (34.1%-100% male; median age, 30-59 years). Fifteen studies were based in Asia and 1 in Europe (Portugal). Five reported data from randomized clinical trials. An oral inspection conducted once or once every 2 to 3 years was described in 11 studies for screening oral cancer, while multistep screening involving Epstein-Barr virus serologic testing for nasopharyngeal carcinoma delivered every 1 to 4 years was presented in 5. In 4 trials and 6 observational studies, screening significantly increased the detection of localized (stage I/II) tumor or was associated with an increased proportion of diagnoses, respectively, regardless of the population and cancer subsites. Universal screening of asymptomatic adults improved 3- to 5-year overall survival but did not increase cancer-specific survival in 4 trials. Targeted screening improved overall and cancer-specific survival or was associated with improved survival outcomes in 2 trials and 2 observational studies, respectively. Studies had low to medium risks of bias.Conclusions and RelevanceEvidence from the existing literature suggests that a risk-targeted screening program for oral and nasopharyngeal cancers could improve diagnosis and patient survival. Screening adherence, societal cost-effectiveness, and optimal risk stratification of such a program warrant future research, especially in low-incidence settings outside Asia.

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Section: Methodsmentioning

confidence: 99%

“…We deemed studies that scored 80% or above, 60% to 80%, and less than 60% to have low, medium, and high risk of bias, respectively. 28 No studies were excluded on the basis of quality.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Sykes,

Weisbrod,

Rival

et al. 2023

JAMA Otolaryngol Head Neck Surg

Self Cite

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“…Specific to women, kidney donation is also associated with increased risk of preeclampsia, gestational hypertension, and preterm birth (Bellos & Pergialiotis, 2022). Finally, economic consequences can include lost wages, child care expenses, and out-of-pocket medical costs (Fu, Sekercioglu, Hishida, & Coyte, 2021). In summary, living organ donation can threatens donors' health and well-being beyond the immediate stresses of surgery.…”

Section: Referencesmentioning

confidence: 99%

The pregnancy compensation hypothesis, not the staying alive theory, accounts for disparate autoimmune functioning of women around the world

Kunz

Goodnight²,

Wilson³

2022

Behav Brain Sci

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“…While living donor kidney transplantation is cost-saving for the healthcare system, it is notable that living donors incur costs in the donation process. In a recent systematic review of publications on donation-related expenses, Fu et al, found that LKDs incurred direct costs ranging between $900 USD to $19,900 USD in the period starting from evaluation to 1-year postdonation [ 15 ]. In addition, indirect costs such as lost wages for donors and caregivers were also identified.…”

Section: Financial Risks Of Living Kidney Donation and The Intersecti...mentioning

confidence: 99%

Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges

et al. 2022

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Purpose of Review While living organ donor follow-up is mandated for 2 years in the USA, formal guidance on recovering associated costs of follow-up care is lacking. In this review, we discuss current billing practices of transplant programs for living kidney donor follow-up, and propose future directions for managing follow-up costs and supporting cost neutrality in donor care. Recent Findings Living donors may incur costs and financial risks in the donation process, including travel, lost time from work, and dependent care. In addition, adherence to the Organ Procurement and Transplantation Network (OPTN) mandate for US transplant programs to submit 6-, 12-, and 24-month postdonation follow-up data to the national registry may incur out-of-pocket medical costs for donors. Notably, the Centers for Medicare and Medicaid Services (CMS) has explicitly disallowed transplant programs to bill routine, mandated follow-up costs to the organ acquisition cost center or to the recipient’s Medicare insurance. We conducted a survey of transplant staff in the USA (distributed October 22, 2020–March 15, 2021), which identified that the mechanisms for recovering or covering the costs of mandated routine postdonation follow-up at responding programs commonly include billing recipients’ private insurance (40%), while 41% bill recipients’ Medicare insurance. Many programs reported utilizing institutional allowancing (up to 50%), and some programs billed the organ acquisition cost center (25%). A small percentage (11%) reported billing donors or donors’ insurance. Summary To maintain a high level of adherence to living donor follow-up without financially burdening donors, up-to-date resources are needed on handling routine donor follow-up costs in ways that are policy-compliant and effective for donors and programs. Development of a government-supported national living donor follow-up registry like the Living Donor Collective may provide solutions for aspects of postdonation follow-up, but requires transplant program commitment to register donors and donor candidates as well as donor engagement with follow-up outreach contacts after donation.

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Economic Consequences of Adult Living Kidney Donation: A Systematic Review

Cited by 30 publications

References 34 publications

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

Methods, Detection Rates, and Survival Outcomes of Screening for Head and Neck Cancers

The pregnancy compensation hypothesis, not the staying alive theory, accounts for disparate autoimmune functioning of women around the world

Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges

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