Cost-effectiveness of Kidney Transplantation From Donors at Increased Risk of Blood-borne Virus Infection Transmission

Abstract

Background. Demand for donor kidneys outstrips supply. Using kidneys from selected donors with an increased risk of blood-borne virus (BBV) transmission (hepatitis B virus and hepatitis C virus [HCV], human immunodeficiency virus) may expand the donor pool, but cost-effectiveness of this strategy is uncertain. Methods. A Markov model was developed using real-world evidence to compare healthcare costs and quality-adjusted life years (QALYs) of accepting kidneys from deceased donors with potential increased risk of BBV transmission, because of increased risk behaviors and/or history of HCV, versus declining these kidneys. Model simulations were run over a 20-y time horizon. Parameter uncertainty was assessed through deterministic and probabilistic sensitivity analyses. Results. Accepting kidneys from donors at increased risk of BBVs (2% from donors with increased-risk behaviors and 5% from donors with active or past HCV infection) incurred total costs of 311 303 Australian dollars with a gain of 8.53 QALYs. Foregoing kidneys from these donors incurred total costs of $330 517 and a gain of 8.44 QALYs. A cost-saving of $19 214 and additional 0.09 QALYs (~33 d in full health) per person would be generated compared with declining these donors. Increasing the availability of kidneys with increased risk by 15% led to further cost-savings of $57 425 and additional 0.23 QALY gains (~84 d in full health). Probabilistic sensitivity analysis using 10 000 iterations showed accepting kidneys from donors at increased risk led to lower costs and higher QALY gains. Conclusions. Shifting clinical practice to accept increased BBV risk donors would likely produce lower costs and higher QALYs for health systems.

Critical pathway for deceased donors: An analysis in three regions of Colombia

“…These two points constitute the limiting step for organ donation, given the fact that some of the contraindications are relative according to the experience and indications of the transplant group as well as the current regulations that allow (or not) the use of donors with conditions like active infections or neoplasms 12 . Karan et al describe a model that assesses the economic benefit of using organs from donors with increased risk of blood-borne virus transmission, like Hepatitis B or C virus, augmenting the donor pool and usage, increasing theoretically 7% the donation rate in New South Wales, Australia 21 . Even though it is desirable that the majority of donors meet standard criteria donors, the changes in the population like the aging population, increase in the prevalence of chronic non-communicable diseases 13,14 , as well as reducing rates of head trauma and better protocols for the attention of neurocritical patients, has made a shift in the ratio of standard vs extended criteria donor, pushing forward the use of those and considering every day more indications for organ donation 8 .…”

Understanding the dynamics of deceased organ donation and utilization in Colombia

“…relative, subject to the experience and guidelines of the transplant groups, as well as the prevailing regulations governing the use of donors with conditions such as active infections or neoplasms (34). Karan et al (35) have described a model that assesses the economic benefits of utilizing organs from donors with an increased risk of blood-borne virus transmission, such as hepatitis B or C virus, thereby expanding the donor pool and utilization. This model theoretically increases the donation rate by 7% in New South Wales, Australia (35).…”

“…Karan et al (35) have described a model that assesses the economic benefits of utilizing organs from donors with an increased risk of blood-borne virus transmission, such as hepatitis B or C virus, thereby expanding the donor pool and utilization. This model theoretically increases the donation rate by 7% in New South Wales, Australia (35).…”