@article{5118c818f1b64db99e2e08a72f8d97ca,
title = "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.",
keywords = "business/management, cost-effectiveness, economics, health services and outcomes research, kidney transplantation/living donor, kidney transplantation/nephrology, organ transplantation, simulation",
author = "Axelrod, {David A.} and Schnitzler, {Mark A.} and Huiling Xiao and William Irish and Elizabeth Tuttle-Newhall and Chang, {Su Hsin} and Kasiske, {Bertram L.} and Tarek Alhamad and Lentine, {Krista L.}",
note = "Funding Information: This work was supported by a grant from the Mid-America Transplant Clinical Innovation Fund “Economic Strategies to Reduce Organ Discard Through Risk-Adjusted Payment Mechanisms.” This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract No. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US government– sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. An abstract describing this work was presented at the American Society of Nephrology Kidney Week, New Orleans, LA, November 2017. Funding Information: Mid-America Transplant Clinical Innovation Fund; Minneapolis Medical Research Foundation, Grant/Award Number: HHSH250201000018C Funding Information: This work was supported by a grant from the Mid-America Transplant Clinical Innovation Fund “Economic Strategies to Reduce Organ Discard Through Risk-Adjusted Payment Mechanisms.” This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract No. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US government–sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. An abstract describing this work was presented at the American Society of Nephrology Kidney Week, New Orleans, LA, November 2017. Publisher Copyright: {\textcopyright} 2018 The American Society of Transplantation and the American Society of Transplant Surgeons",
year = "2018",
month = may,
doi = "10.1111/ajt.14702",
language = "English (US)",
volume = "18",
pages = "1168--1176",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Elsevier B.V.",
number = "5",
}