The economic burden of kidney graft failure in the United States

Abstract

Despite improvements in outcomes for kidney transplant recipients in the past decade, graft failure continues to impose substantial burden on patients. However, the population‐wide economic burden of graft failure has not been quantified. This study aims to fill that gap by comparing outcomes from a simulation model of kidney transplant patients in which patients are at risk for graft failure with an alternative simulation in which the risk of graft failure is assumed to be zero. Transitions through the model were estimated using Scientific Registry of Transplant Recipients data from 1987 to 2017. We estimated lifetime costs, overall survival, and quality‐adjusted life‐years (QALYs) for both scenarios and calculated the difference between them to obtain the burden of graft failure. We find that for the average patient, graft failure will impose additional medical costs of $78 079 (95% confidence interval [CI] $41 074, $112 409) and a loss of 1.66 QALYs (95% CI 1.15, 2.18). Given 17 644 kidney transplants in 2017, the total incremental lifetime medical costs associated with graft failure is $1.38B (95% CI $725M, $1.98B) and the total QALY loss is 29 289 (95% CI 20 291, 38 464). Efforts to reduce the incidence of graft failure or to mitigate its impact are urgently needed.

Understanding and using AlloSure donor derived cell-free DNA

“…Sussell et al have shown that, despite improvements in outcomes for kidney transplant recipients in the past decade, graft failure continues to impose substantial burden on patients (Sussell et al 2020 ). In this study, authors compared outcomes from a simulation model of kidney transplant patients, in which patients who were at risk for graft failure were compared with an alternative simulation in which the risk of graft failure is assumed to be zero.…”

Effect of Perioperative Dexmedetomidine on Delayed Graft Function Following a Donation-After-Cardiac-Death Kidney Transplant

“…The median length of hospital stay of 25 days in this trial was in line with the data originated in China 46 , 47 but appeared much longer than that in the US and European countries. 48 , 49 , 50 This difference may be attributed to the different health care systems in various countries. Fourth, as a single-center trial based on controlled donors after cardiac death and characterized by a relatively short warm ischemic time, the generalizability of its findings should be tested in future studies.…”

Long-term Outcome Reporting in Older Kidney Transplant Recipients and the Limitations of Conventional Survival Metrics

“…In the kidney transplant literature multistate models have mainly, but not exclusively, been applied in studies of outcomes of waitlisted patients. 25 , 26 , 27 , 28 They are a natural fit here, because waitlisted patients can transition between several different states (e.g., listed active, listed inactive, death on the waitlist, removed from waitlist, transplanted). Multistate models can also be a useful adjunct to traditional survival analyses in several ways.…”