Cost Analysis of Human Islet Transplantation for the Treatment of Type 1 Diabetes in the Swiss-French Consortium GRAGIL

Abstract

OBJECTIVE -To evaluate the cost of islet transplantation in type 1 diabetic patients with a functional renal graft in a multicenter network.RESEARCH DESIGN AND METHODS -The study involved nine diabetic patients transplanted in the Swiss-French Groupe Rhô ne-Alpes, Rhin et Geneve pour la transplantation d'Ilots Langerhans (GRAGIL) consortium between March 1999 and June 2000. The direct medical costs were estimated from Social Security's perspective from the inclusion of the patient to 1 year after transplantation. All cost components were computed separately and included evaluation, screening and candidacy, organ retrieval, islet processing, pancreas and islet transportation, hospitalization for transplantation, follow-up, medications (immunosuppressive, antidiabetic, and adjuvant drugs), and adverse events requiring hospitalization.RESULTS -During the study period, 56 pancreata were processed and 14 islet preparations were transplanted. The average cost of an islet transplantation (procedure and 1-year follow-up) was €77,745 (French rate, year 2000). The four main cost components were islet preparation (30% of the total cost), adverse events (24%), drugs (14%), and hospitalization (13%).CONCLUSIONS -Overall costs of islet transplantation are slightly higher than those of pancreas transplantation. The cell isolation process is a critical point; a reduction in overall cost will require more efficient ways of isolating high yields of viable islets. Costs generated by shipments within the GRAGIL network did not represent an economic burden. It can be expected that the costs will decrease with growing experience and improving technology. Diabetes Care 27:895-900, 2004I slet transplantation is a promising experimental treatment for type 1 diabetes (1-3). It is widely recognized that tight control of blood glucose levels reduces diabetes-related morbidity and mortality (4,5) and can prohibit or delay the development of costly complications (6 -12). Islet replacement, by either islet or whole-pancreas transplantation, is the sole therapy to achieve independence from exogenous insulin and a constant normoglycemic state, avoiding hypoglycemic episodes (13). By June 2001, the 1-year insulin independence rate in 237 adult islet allograft recipients performed worldwide between 1990 and 1999 and reported by the Giessen Islet International Registry was 11% (14). Recently, significant improvements in the outcome of islet transplantation have been recorded, in particular, those achieved by the Edmonton protocol (15,16). In contrast, pancreas-alone transplantation and simultaneous kidney-pancreas transplantation achieve, according to the 2000 United Network for Organ SharingOrgan Procurement and Transplantation Network (UNOS OPTN) report, 76 and 84% insulin independence rates at 1 year, respectively (17). However, whole-or segmental-pancreas transplants are complex surgical procedures and are associated with significant mortality and morbidity (18). Thus, islet transplantation is an alternative for many individuals who have the m...

Human pancreatic islet transplantation: an update and description of the establishment of a pancreatic islet isolation laboratory

“…In 2004, a French study evaluated the cost of islet transplantation from the time of organ removal until the transplant itself and its follow-up. The study found that islet isolation was the most expensive phase of the process, accounting for 30% of total transplant costs (36). A similar situation has been reported in Brazil, where the reliance on imported isolation reagents may lead costs to rise even further (61).…”

“…However, the clinical applicability of islet transplantation in many health centers is limited by the complexity of islet isolation processes, the high cost (34,36) and the scarcity of donor organs (37). Since each transplant patient generally requires islets isolated from two to three donors in order to improve rates of insulin independence (37), there is a significant interest in developing methods for isolating the greatest number of viable islets from the pancreas of each donor.…”

Five-Year Metabolic, Functional, and Safety Results of Patients With Type 1 Diabetes Transplanted With Allogenic Islets Within the Swiss-French GRAGIL Network

“…The mean length of hospitalization was 5.8 days/islet infusion/patient. Our group previously published a 1-year cost analysis of islet transplantation and described a mean hospitalization length of 15.6 days/patient over 1 year with total costs slightly higher than the costs of whole-organ pancreas transplantation (38). During the entire 5 years of follow-up, mean hospitalization duration, including all hospitalization stays for each islet infusion, and eventually for the occurrence of adverse events, fell to 7.05 days/patient/year.…”

Using HTK for Prolonged Pancreas Preservation Prior to Human Islet Isolation

“…However, these studies assessed only pancreata preserved for a relatively short period of CIT [12,13]. Currently, efforts are ongoing to centralize clinical islet isolation in highly experienced units to maximize resources and reduce costs [14,15]. On the other hand, this may result in prolonged transportation, thus increasing CIT.…”