An economic assessment of contemporary kidney transplant practice

David A Axelrod, Mark A Schnitzler, Huiling Xiao, William Irish, Elizabeth Tuttle-Newhall, Su-Hsin Chang, Bertram L Kasiske, Tarek Alhamad, Krista L Lentine

Kidney transplant is the optimal therapy for end stage renal disease, prolonging survival and reducing healthcare spending. Prior economic analyses of kidney transplant using Markov models, have generally assumed compatible, low risk, donors. The economic implications of using deceased donor kidneys with high kidney donor profile index (KPDI) scores, ABO incompatible or HLA incompatible living donors has not been assessed. The costs of transplant and dialysis were compared using discrete event simulation over a 10-year period, using data from the United States Renal Data System, Vizient™(Irving, Texas), and literature review. Graft failure rates and expenditures were adjusted for donor characteristics. All transplant options were associated with improved survival compared with dialysis (transplant: 5.20-6.34 quality adjusted life years [QALY] vs. dialysis: 4.03 QALY). Living donor and low KDPI deceased donor transplants were cost saving compared with dialysis, while transplants 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 transplant to 80,486 for HLA incompatible donors compared with $72,476 for dialysis. In conclusion, kidney transplant is cost-effective across all donor types despite higher costs for marginal organs and innovative living donor practices. This article is protected by copyright. All rights reserved.