Health‐related quality of life in kidney transplant patients with diabetes

Dukes, Jonathan; Seelam, Susmitha; Lentine, Krista L.; Neri, Luca

doi:10.1111/ctr.12198

Cited by 15 publications

(17 citation statements)

References 36 publications

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“…402 This is a recent study 402 in the relevant patient population and reports EQ-5D utility data, with an estimated disutility of 0.06 associated with NODAT. This figure does not adjust for people with CVD complications and therefore is appropriate to how we model NODAT.…”

Section: Disutility Due To Diabetes Mellitusmentioning

confidence: 99%

“…This figure does not adjust for people with CVD complications and therefore is appropriate to how we model NODAT. We note that the study 402 was conducted in only one hospital in USA and the valuation set for the utility values is US based, 403 so the outcomes may not be generalisable to the UK population. It has been demonstrated by Johnson et al 404 that US-valued health states are statistically higher than the UK-valued health states for 31 out of 42 valued EQ-5D health states and that extreme health states are most notably different.…”

Section: Disutility Due To Diabetes Mellitusmentioning

confidence: 99%

See 1 more Smart Citation

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect®, Novartis Pharmaceuticals UK Ltd) and rabbit anti-human thymocyte immunoglobulin (rATG) (Thymoglobulin®, Sanofi) as induction therapy, and immediate-release tacrolimus (TAC) (Adoport®, Sandoz; Capexion®, Mylan; Modigraf®, Astellas Pharma; Perixis®, Accord Healthcare; Prograf®, Astellas Pharma; Tacni®, Teva; Vivadex®, Dexcel Pharma), prolonged-release tacrolimus (Advagraf®Astellas Pharma), belatacept (BEL) (Nulojix®, Bristol-Myers Squibb), mycophenolate mofetil (MMF) (Arzip®, Zentiva; CellCept®, Roche Products; Myfenax®, Teva), mycophenolate sodium (MPS) (Myfortic®, Novartis Pharmaceuticals UK Ltd), sirolimus (SRL) (Rapamune®, Pfizer) and everolimus (EVL) (Certican®, Novartis) as maintenance therapy in adult renal transplantation.MethodsClinical effectiveness searches were conducted until 18 November 2014 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science (via ISI), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted until 18 November 2014 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Database (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and the American Economic Association’s electronic bibliography (via EconLit, EBSCOhost). Included studies were selected according to predefined methods and criteria. A random-effects model was used to analyse clinical effectiveness data (odds ratios for binary data and mean differences for continuous data). Network meta-analyses were undertaken within a Bayesian framework. A new discrete time–state transition economic model (semi-Markov) was developed, with acute rejection, graft function (GRF) and new-onset diabetes mellitus used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsEighty-nine randomised controlled trials (RCTs), of variable quality, were included. For induction therapy, no treatment appeared more effective than another in reducing graft loss or mortality. Compared with placebo/no induction, rATG and BAS appeared more effective in reducing biopsy-proven acute rejection (BPAR) and BAS appeared more effective at improving GRF. For maintenance therapy, no treatment was better for all outcomes and no treatment appeared most effective at reducing graft loss. BEL + MMF appeared more effective than TAC + MMF and SRL + MMF at reducing mortality. MMF + CSA (ciclosporin), TAC + MMF, SRL + TAC, TAC + AZA (azathioprine) and EVL + CSA appeared more effective than CSA + AZA and EVL + MPS at reducing BPAR. SRL + AZA, TAC + AZA, TAC + MMF and BEL + MMF appeared to improve GRF compared with CSA + AZA and MMF + CSA. In the base-case deterministic and probabilistic analyses, BAS, MMF and TAC were predicted to be cost-effective at £20,000 and £30,000 per quality-adjusted life-year (QALY). When comparing all regimens, only BAS + TAC + MMF was cost-effective at £20,000 and £30,000 per QALY.LimitationsFor included trials, there was substantial methodological heterogeneity, few trials reported follow-up beyond 1 year, and there were insufficient data to perform subgroup analysis. Treatment discontinuation and switching were not modelled.Future workHigh-quality, better-reported, longer-term RCTs are needed. Ideally, these would be sufficiently powered for subgroup analysis and include health-related quality of life as an outcome.ConclusionOnly a regimen of BAS induction followed by maintenance with TAC and MMF is likely to be cost-effective at £20,000–30,000 per QALY.Study registrationThis study is registered as PROSPERO CRD42014013189.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Disutility Due To Diabetes Mellitusmentioning

confidence: 99%

Section: Disutility Due To Diabetes Mellitusmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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“…Some of the items may be irrelevant to measure QoL after transplantation and may neglect other issues likely to be important . Several other generic instruments have been used to evaluate QoL in transplanted patients, namely the Karnofsky Index and the EuroQol‐5 Dimensions (EQ‐5D) . Disease‐specific surveys have been developed to measure changes in particular diseases, mostly after a treatment.…”

mentioning

confidence: 99%

“…We asked each patient who consented to participate in this study, the changes felt from pre‐transplantation to the present, after transplantation. The EQ‐5D‐5L has already been validated for Portuguese population and in renal transplants without or with diabetes . The GIQLI has also been used and validated in renal transplants for the Spanish population .…”

mentioning

confidence: 99%

Health‐related quality of life may improve after transplantation in pancreas–kidney recipients

Martins

Outerelo

Malheiro

et al. 2015

Clinical Transplantation

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Pancreas-kidney transplantation (PKT) may significantly improve quality of life (HRQOL) in patients with type 1 diabetes. We have assessed the changes felt by PKT patients, using the Gastrointestinal Quality of Life Index (GIQLI) and EuroQol-5D questionnaires. Patients were asked to compare how their HRQOL had changed from pre-transplantation to the last visit. The 60 men and 66 women enrolled had a mean follow-up of five yr; 84.1% with both grafts, 15.9% with one graft functioning. In all domains of EuroQol-5D scores improved after PKT, as well as the visual analogue scale health state (from 38% to 84%, p < 0.001; effect size 3.34). In GIQLI, physical function was felt better after PKT than before (14.83 ± 3.86 vs. 7.86 ± 4.43, p < 0.001; effect size 1.68); the same was observed for psychological status, social function, and GI complaints. Concerning the burden of medical treatment, the score significantly improved (from 1.31 to 3.63, p < 0.001, effect size 2.02). The rate of unemployed patients decreased after PKT (from 50.8% to 36.5%, p < 0.001). Multivariate analysis showed that having only one functioning graft was associated with worse HRQOL scores (B = -5.157, p = 0.015). In conclusion, for all assessed domains, patients reported a significant improvement in HRQOL after PKT. Maintenance of the two grafts functioning predicted higher improvement of HRQOL scores.

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“…(17) One single-institution study found that non-diabetics had a significantly higher health-related quality of life following renal transplantation. (18) Given that co-morbid diabetes is lower among older recipients, it is possible that this finding may be generalizable to a large number of this population. Our findings may also aid in educating older recipients regarding the relative hazards associated with the transplantation of select donor organs of lesser quality.…”

Section: Discussionmentioning

confidence: 87%

The Combined Risk of Donor Quality and Recipient Age

et al. 2014

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Background The Kidney Donor Profile Index (KDPI) is a more precise donor organ quality metric replacing age-based characterization of donor risk. Little prior attention has been paid on the outcomes of lower quality kidneys transplanted into elderly recipients. Although we have previously shown that immunological risks associated with older organs are attenuated by advanced recipient age it remains unknown whether risks associated with lower quality KDPI organs are similarly reduced in older recipients. Methods Donor organ quality as measured by the KDPI was divided into quintiles (very high, high, medium, low, and very low quality) and Cox proportional hazards was used to assess graft and recipient survival in first-time adult deceased donor transplant recipients by recipient age. Results In uncensored graft survival analysis, recipients >69 years had comparable outcomes if they received low quality compared to medium quality kidneys. Death-censored analysis demonstrated no increased relative risk when low quality kidneys were transplanted into recipients 70–79 years (HR1.11, p=0.19) or >79 years (HR1.08, p=0.59). In overall survival analysis, elderly recipients gained no relative benefit from medium over low quality kidneys (70–79 years: HR1.03, p=0.51; >79 years: HR1.08, p=0.32). Conclusions Our analysis demonstrates that transplanting medium quality kidneys into elderly recipients does not provide significant advantage over low quality kidneys.

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Health‐related quality of life in kidney transplant patients with diabetes

Abstract: Among kidney transplant patients between the ages of 18-74, non-diabetics have significantly higher HRQOL scores on the EQ-5D, HUI-III, and SF-6D compared with patients with diabetes.

Cited by 15 publications

References 36 publications

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Health‐related quality of life may improve after transplantation in pancreas–kidney recipients

The Combined Risk of Donor Quality and Recipient Age

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