Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities

Abstract

BackgroundDeceased donor kidneys for transplantation are in most countries allocated preferentially to recipients who have limited co-morbidities. Little is known about the incremental health and economic gain from transplanting those with co-morbidities compared to remaining on dialysis. The aim of our study is to estimate the average and incremental survival benefits and health care costs of listing and transplantation compared to dialysis among individuals with varying co-morbidities.MethodsA probabilistic Markov model was constructed, using current outcomes for patients with defined co-morbidities treated with either dialysis or transplantation, to compare the health and economic benefits of listing and transplantation with dialysis.FindingsUsing the current waiting time for deceased donor transplantation, transplanting a potential recipient, with or without co-morbidities achieves survival gains of between 6 months and more than three life years compared to remaining on dialysis, with an average incremental cost-effectiveness ratio (ICER) of less than $50,000/LYS, even among those with advanced age. Age at listing and the waiting time for transplantation are the most influential variables within the model. If there were an unlimited supply of organs and no waiting time, transplanting the younger and healthier individuals saves the most number of life years and is cost-saving, whereas transplanting the middle-age to older patients still achieves substantial incremental gains in life expectancy compared to being on dialysis.ConclusionsOur modelled analyses suggest transplanting the younger and healthier individuals with end-stage kidney disease maximises survival gains and saves money. Listing and transplanting those with considerable co-morbidities is also cost-effective and achieves substantial survival gains compared with the dialysis alternative. Preferentially excluding the older and sicker individuals cannot be justified on utilitarian grounds.

Preemptive Deceased Donor Kidney Transplantation

“…Kidney transplantation significantly improves life expectancy and reduces costs for dialysis patients (2,15), but this improvement has not been shown in predialysis CKD. Although time on dialysis (dialysis vintage) strongly associates with recipient mortality (16)(17)(18), no study has shown that preemptive DDKT improves on DDKT among those patients with short dialysis vintage.…”

Organ donation in the UK: how general practice can help

“…1,2 Organs routinely transplanted include heart, lung, liver, pancreas, and bowel but other organs that may be transplanted include thymus, hand, face, leg, abdominal wall, and uterus. The last two decades have seen major changes in organ transplantation: developments in surgery, anaesthesia, interventional radiology, microbiology, and pharmacology have transformed what many still today believe is a high intensity, high risk procedure with a high mortality to a routine procedure with low morbidity and a high long-term success rate.…”

Scarcity discourses and their impacts on renal care policy, practices, and everyday experiences in rural British Columbia

“…Over a fiveyear period, a kidney transplant saves the health care system over $100,000 compared with in-clinic dialysis (ibid). A number of studies have found transplants to be more cost effective than dialysis (Wong et al, 2012;Howard et al, 2009). From political and economic perspectives, increasing the number of transplants performed is highly desirable.…”