Cost-effectiveness of post-transplantation quality of life intervention among kidney recipients

Background: The purpose was to demonstrate the cost-effectiveness of an experimental post-transplant care program designed to improve kidney transplant recipients' quality of life (QoL). The intervention program integrated a three-pronged interdisciplinary approach emphasizing: (i) proactive, patient-initiated care to prevent transplant-related morbidities, (ii) employment/vocational counseling, and (iii) enhancement of social support. Methods: A cost-effectiveness analysis of a clinical trial was performed comparing QoL and costs in two groups: a retrospective cohort (n = 30) and those who received the experimental interventions (n = 150). Data were collected at baseline, 6 and 12 months. The number of quality-adjusted 'treatment-free days' was used as the primary outcome. The costs included those for direct intervention, direct inpatient and outpatient post-transplant health care, and indirect out-of-pocket expenses borne by patients. Results: Patients in the intervention group had more quality-adjusted treatment-free days (289 vs. 272 and statistically significant) and lower cost per patient (although not statistically significant). Further, the superior outcome was delivered at an incremental cost of $29 per quality-adjusted treatment-free day. A one-way sensitivity analysis confirmed the robustness of the results. Conclusion: The experimental post-transplant care program is both effective and cost-effective; the superior results are attributed to improved QoL.