Living Renal Donors: Optimizing the Imaging Strategy—Decision- and Cost-effectiveness Analysis

Liem, Ylian S.; Kock, Marc C. J. M.; IJzermans, Jan N. M.; Weimar, Willem; Visser, Karen; Hunink, M. G. Myriam

doi:10.1148/radiol.2261011893

Cited by 26 publications

(15 citation statements)

References 55 publications

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“…Increased donor willingness to undergo evaluation and donation benefits recipients. Transplant centers benefit by reduced donor evaluation costs (28). As for surgeons, successful donor and recipient procedures can be accomplished despite consternation with unanticipated findings due to inaccurate scans.…”

Section: Discussionmentioning

confidence: 99%

Pre-donation Assessment of Kidneys by Magnetic Resonance Angiography and Venography: Accuracy and Impact on Outcomes

Ames

Krol²,

Nettar

et al. 2005

American Journal of Transplantation

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Reports on the accuracy of magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) in evaluating living donor renovasculature employ few patients or omit the consequences of inaccurate scans. We retrospectively compared intraoperative findings to MRA/MRV scans in 146 donorrecipient pairs. For detecting accessory arteries and early branching, MRA sensitivity was 57.6%, specificity 96.5%, false positive rate 3.5%, false negative rate 42.4%, positive predictive value 82.6%, negative predictive value 88.6% and overall accuracy 87.7%. By excluding clinically inconsequential accessory arteries, MRA sensitivity rose to 73.1%, specificity to 96.7% and overall accuracy to 92.5%. For MRVs, sensitivity was 56.2%, specificity 99%, false positive rate 1%, false negative rate 43.8%, positive predictive value 90%, negative predictive value 94.8% and accuracy 94.5%. Inaccurate scans were associated with prolonged donor and recipient operations and more frequently reconstructed arteries, but did not affect clinical outcomes. Because most missed accessory arteries are inconsequential, MRA is a useful, less invasive method for defining donor renovascular anatomy.

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Section: Discussionmentioning

confidence: 99%

Pre-donation Assessment of Kidneys by Magnetic Resonance Angiography and Venography: Accuracy and Impact on Outcomes

Ames

Krol²,

Nettar

et al. 2005

American Journal of Transplantation

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“…Specific situations in which spillover effects are critical inputs for decision analysis have been identified, including for measurement reasons, such as utilities for health states of very young children in which the parent proxy cannot reasonably separate their own utility from that of the child 24 , or for face validity reasons, such as living organ transplant in which both donor and recipient are integral to the decision. 25 The study reported here estimated the spillover disutility of all chronic conditions experienced by a sample of the US population, measured using one utility instrument(the EuroQol-5D (EQ-5D)). These values will inform economic evaluations based on QALYs.…”

Section: Introductionmentioning

confidence: 99%

Evidence of Spillover of Illness among Household Members

2012

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Background/Objectives: The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members’ health-related quality of life. Methods: Medical Expenditures Panel Survey (MEPS) data from 2000–2003 were analyzed using multivariable regression to identify spillover of household members’ chronic conditions onto individuals’ health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child). Results: Controlling for an individual’s own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64–0.79), respiratory (0.85; 0.75–0.97), and musculoskeletal (0.83; 0.75–0.93) conditions among adults and with mental (0.72; 0.62–0.82) and respiratory (0.80; 0.81–0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults’ mental (0.79; 0.65–0.97), nervous/sensory system (0.76; 0.61–0.96), and musculoskeletal (0.78; 0.65–0.95) conditions and children’s mental conditions (0.64; 0.48–0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members. Conclusions: Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.

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“…Clinical research over many years including calculation of the ICUR of different diseases and comparative therapy and cost-effectiveness analyses of therapy related to chronic renal failure [5,6,7,8,9,10,11] have suggested that prevention of renal failure in patients with diabetes costs approximately USD 2,000-30,000/Qaly, which is better than the cost of normal HD (dialysis in regular facilities) of about USD 50,000/Qaly. These studies also showed that renal transplantation (including donors from fatalities and patients aged ≥65 years) cost USD 10,000-70,000/Qaly, generally indicating good value.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of On-Line Hemodiafiltration in Japan

Takura

Kawanishi²,

Murata³

et al. 2013

Blood Purif

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Background/Aims: Evaluation of the socioeconomic value of medical intervention and establishment of the resources necessary for clinical practice are important for new developments in medical technology. The aim of this study was to determine the socioeconomic value of on-line hemodiafiltration (HDF). Methods: The subjects were 24 patients who underwent hemodialysis (HD) (9 HDF, 15 HD) for chronic renal failure. A total of 288 dialysis interventions were observed for 4 weeks in three clinics. Cost-effectiveness was evaluated based on quality-adjusted life years (Qaly) and a visual analog scale. Results: EuroQOL-5D (0.776 ± 0.015) and visual analog scale (67.9 ± 1.2) in the HDF group were higher than those in the HD group at baseline. The incremental cost utility ratio for HDF was 641.7 (JPY 10,000/Qaly) based on Qaly (0.776 ± 0.015) and reimbursement for medical fees (JPY 4,982,736 ± 7,852), and was lower than the incremental cost utility ratio for HD. Conclusion: These results suggest that on-line HDF could be cost-effective.

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Living Renal Donors: Optimizing the Imaging Strategy—Decision- and Cost-effectiveness Analysis

Cited by 26 publications

References 55 publications

Pre-donation Assessment of Kidneys by Magnetic Resonance Angiography and Venography: Accuracy and Impact on Outcomes

Pre-donation Assessment of Kidneys by Magnetic Resonance Angiography and Venography: Accuracy and Impact on Outcomes

Evidence of Spillover of Illness among Household Members

Cost-Effectiveness Analysis of On-Line Hemodiafiltration in Japan

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