Is simultaneous pancreas kidney transplant the most cost-effective strategy for type 1 diabetes patients with renal failure?

Abstract

Introduction: Simultaneous pancreas kidney transplant (SPK) has shown beneficial outcomes in type 1 diabetes patients with renal failure (IDDM-RF). The objective of this study was to assess its cost-effectiveness compared with other treatment strategies for IDDM-RF. Methods: A decision analytic model was developed for IDDM-RF treatment with four possible strategies: deceased donor kidney transplant (DDKT), living donor kidney transplant (LDKT), SPK and dialysis. A cost-utility analysis from the healthcare provider perspective was conducted based on a five-year model. Local data were used whenever possible except for SPK survival variables, wherein data from United Network for Organ Sharing and Scientific Registry of Transplant Recipients were used. Sensitivity analyses were performed to evaluate the impact of uncertainties around key variables. Results: In the baseline analysis, LDKT was the most cost-effective strategy with the lowest cost per quality-adjusted life year gained, i.e. SGD77,068, followed by SPK (SGD82,991), DDKT (SGD92,432) and dialysis (SGD181,192). The DDKT was extended dominated by dialysis and LDKT strategies. Incremental cost-effectiveness ratios with dialysis as a reference for LDKT and SPK strategies were SGD43,094 and SGD56,201, respectively. Both strategies are considered highly cost-effective under World Health Organization (WHO) guidelines. In the sensitivity analysis, a 6% increase in both SPK kidney graft survival and patient survival would make SPK the most cost-effective strategy. Conclusions: Both LDKT and SPK are highly cost-effective strategies in the treatment of IDDM-RF. SPK is potentially the most cost-effective strategy if a 6% increase in both SPK kidney graft survival and patient survival is achieved.

Relative survival and quality of life benefits of pancreas–kidney transplantation, deceased kidney transplantation and dialysis in type 1 diabetes mellitus—a probabilistic simulation model

“…Douzdijan et al . [6] found SPK transplantation yielded the best gains in QALY at five years (2.36), compared to deceased donor kidney alone transplantation (1.38) and dialysis (0.68) [24]. This has been corroborated by more recent data.…”

“…Furthermore, using registry data from Singapore and the United States, Ong et al . [24] also found that SPK transplantation yielded the best QALY at five years (3.03), compared to deceased donor kidney alone transplantation (2.08) and dialysis (0.64). While the previous studies demonstrate the survival advantages of SPK transplantation over deceased donor kidney transplantation and dialysis, the present study also accounts for recipient age interactions and uses a probabilistic rather than a deterministic approach to determine the incremental benefits in life years and quality‐adjusted LYS.…”

“…and Ong et al . have previously examined the relative benefits of SPK transplantation versus dialysis using decision analytic models [6,11,24]. By defining the various transition health states (e.g.…”

“…A strength of our study is that it examines the survival benefits of SPK for type 1 diabetes using post‐2006 data. Previous studies occurred in an era with exocrine bladder drainage for SPK transplantation, and different immunosuppressive therapies may not translate to contemporary clinical practice [5,6,24,30]. In recent years, bladder drainage has been superseded by enteric drainage, given that chronic exposure to pancreatic enzymatic secretions is associated with metabolic and urological complications in bladder drained organs [31,32].…”