Variation in Cost and Quality in Kidney Transplantation

Nassir, Bishara A.; Dean, Carl; Li, Suying; Salkowski, Nicholas; Solid, Craig A.; Snyder, Jon J.; Kim, S. Joseph; Kasiske, Bertram L.; Linzer, Mark; Israni, Ajay K.

doi:10.1097/tp.0000000000000721

Cited by 20 publications

(11 citation statements)

References 28 publications

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“…Chronic kidney disease and particularly end‐stage renal disease are associated with relevant burdens in terms of both healthcare expenditures and patients’ quality of life . To the best of our knowledge, few studies on the costs and resource consumption of patients receiving KTx have been published, particularly studies focused on the period before and after transplant surgery . Because of differences in healthcare reimbursement settings, the medical resources considered and study designs, a comparison between the present study and the ones reported above would not be suitable even if the majority of those studies had found that KTx offered cost savings vs dialysis.…”

Section: Discussionmentioning

confidence: 87%

“…Compared with transplantation after beginning dialysis, a reduction of 25% in transplant failure and 16% in mortality could be achieved with preemptive transplantation . In 2017, 1927 kidney transplants (including multiorgan transplants) were performed in Italy, representing an increase of 7.3% compared to 2016, due to a greater number of transplants from living donors (5%) and from deceased donors (10%), but this increase only slightly reduced the waiting list (6492 still pending in December 2017) . Very limited evidence is actually available regarding the direct healthcare costs associated with renal transplantations at the international and, especially, at the Italian level .…”

Section: Introductionmentioning

confidence: 99%

“…In 2017, 1927 kidney transplants (including multiorgan transplants) were performed in Italy, representing an increase of 7.3% compared to 2016, due to a greater number of transplants from living donors (5%) and from deceased donors (10%), but this increase only slightly reduced the waiting list (6492 still pending in December 2017) . Very limited evidence is actually available regarding the direct healthcare costs associated with renal transplantations at the international and, especially, at the Italian level . The present study analyzes the information collected in the administrative database of the largest Italian region (Lombardy, which has approximately 9.7 million inhabitants, representing 16% of the entire Italian population of approximately 59 million people) for all patients receiving a kidney transplant (KTx) in the year 2011.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Real‐world data on healthcare resource consumption and costs before and after kidney transplantation

Roggeri¹,

Roggeri²,

Zocchetti³

et al. 2019

Clinical Transplantation

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End-stage renal disease (ESRD) is increasing worldwide as a consequence of population aging and increasing chronic illness. Treatment consists mostly of dialysis and kidney transplantation (KTx), and KTx offers advantages for life expectancy and longterm cost reductions compared with dialysis. This study uses the administrative database of the Lombardy Region to analyze the costs of a cohort of patients with ESRD receiving KTx, covering a time period of 24 months before transplant to 12 months after. During 2011, 276 patients underwent kidney transplantation (8.7% preemptive and 91.3% non-preemptive). In the period before transplantation, the main cost driver was dialysis (66.6% for the period from −24 to −12 months and 73.8% for the period from −12 to 0 months), while in the 12 months after KTx, the most relevant cost was surgery. The total cost −24 to −12 months pre-KTx was 35 049.2€; the cost −12 to 0 months was 36 745.9€; and the cost 12 months after KTx was 43 805.8€. Nonpreemptive patients showed much higher costs both pre-and post-KTx than preemptive patients. This study highlights how KTx modifies the resource consumption and costs composition of patients with ESRD vs those undergoing dialysis treatment and how KTx may be economically beneficial, especially preemptive intervention.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Real‐world data on healthcare resource consumption and costs before and after kidney transplantation

Roggeri¹,

Roggeri²,

Zocchetti³

et al. 2019

Clinical Transplantation

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“…When available, we used the cPRA recorded at the time of transplant. For patients transplanted prior to routine use of cPRA, we incorporated the PRA at the time of transplant when available or the peak PRA if no PRA at transplant was recorded . Other variables including cause of ESRD, cause of donor death, and payer definitions were based on OPTN records.…”

Section: Methodsmentioning

confidence: 99%

The Changing Financial Landscape of Renal Transplant Practice: A National Cohort Analysis

Axelrod

Schnitzler

Xiao

et al. 2017

American Journal of Transplantation

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Kidney transplantation has become more resource intensive as recipient complexity has increased and average donor quality has diminished over time. A national retrospective cohort study was performed to assess the impact of kidney donor and recipient characteristics on transplant center cost (exclusive of organ acquisition) and Medicare reimbursement. Data from the national transplant registry, University HealthSystem Consortium hospital costs, and Medicare payments for deceased donor (N=53,862) and living donor (N=36,715) transplants from 2002–2013 were linked and analyzed using multivariate linear regression modeling. Deceased donor kidney transplant costs were correlated with recipient (Expected Post Transplant Survival Score, degree of allosensitization, obesity, cause of renal failure) donor (age, cause of death, donation after cardiac death, terminal creatinine), and transplant (histocompatibility matching) characteristics. Living donor costs rose sharply with higher degrees of allosensitization, and were also associated with obesity, cause of renal failure, recipient work ability, and 0-ABDR mismatching. Analysis of Medicare payments for a subsample of 24,809 transplants demonstrated minimal correlation with patient and donor characteristics. In conclusion, the complexity in the landscape of kidney transplantation increases center costs, posing financial disincentives that may reduce organ utilization and limit access for higher risk populations.

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“…Whereas the costs for most aspects of the organ transplant process have been reported, the functional OPO cost, generally referred to as the organ acquisition cost (OAC), has not been widely researched . As a consequence of the National Organ Transplantation Act (NOTA), OPOs have a defined method of assessing OAC, and the aggregate costs incurred by any OPO are unique to that OPO.…”

Section: Introductionmentioning

confidence: 99%

The cost of procuring deceased donor kidneys: Evidence from OPO cost reports 2013-2017

Held

Bragg‐Gresham

Peters

et al. 2020

American Journal of Transplantation

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Using 5 years of US organ procurement organization (OPO) data, we determined the cost of recovering a viable (ie, transplanted) kidney for each of 51 OPOs. We also examined the effects on OPO costs of the recovery of nonviable (ie, discarded) kidneys and other OPO metrics. Annual cost reports from 51 independent OPOs were used to determine the cost per recovered kidney for each OPO. A quadratic regression model was employed to estimate the relationship between the cost of kidneys and the number of viable kidneys recovered, as well as other OPO performance indicators. The cost of transplanted kidneys at individual OPOs ranged widely from $24 000 to $56 000, and the average was $36 000. The cost of a viable kidney tended to decline with the number of kidneys procured up to 549 kidneys per year and then increase. Of the total 81 401 kidneys recovered, 66 454 were viable and 14 947 (18.4%) were nonviable. The costs of kidneys varied widely over the OPOs studied, and costs were a function of the recovered number of viable and nonviable organs, local cost levels, donation after cardiac death, year, and Standardized Donor Rate Ratio. Cost increases were 3% per year.

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Variation in Cost and Quality in Kidney Transplantation

Abstract: Further investigations are needed to determine specific cost-effective practices of higher- and lower-performing centers to reduce costs and incidence of allograft failure.

Cited by 20 publications

References 28 publications

Real‐world data on healthcare resource consumption and costs before and after kidney transplantation

Real‐world data on healthcare resource consumption and costs before and after kidney transplantation

The Changing Financial Landscape of Renal Transplant Practice: A National Cohort Analysis

The cost of procuring deceased donor kidneys: Evidence from OPO cost reports 2013-2017

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