What are the short-term annual cost savings associated with kidney transplantation?

Abstract

Background Kidney transplantation (KT) is often reported in the literature as associated with cost savings. However, existing studies differ in their choice of comparator, follow-up period, and the study perspective. Also, there may be unobservable heterogeneity in health care costs in the patient population which may divide the population into groups with differences in cost distributions. This study estimates the cost savings associated with KT from a payer perspective and identifies and characterizes both high and low patient cost groups. Method The current study was a population-based retrospective before-and-after study. The timespan involved at most three years before and after KT. The sample included end-stage kidney disease patients in Nova Scotia, a province in Canada, who had a single KT between January 1, 2011, and December 31, 2018. Each patient served as their control. The primary outcome measure was total annual health care costs. We estimated cost savings using unadjusted and adjusted models, stratifying the analyses by donor type. We quantified the uncertainty around the estimates using non-parametric and parametric bootstrapping. We also used finite mixture models to identify data-driven cost groups based on patients’ pre-transplantation annual inpatient costs. Results The mean annual cost savings per patient associated with KT was $19,589 (95% CI: $14,013, $23,397). KT was associated with a 24–29% decrease in mean annual health care costs per patient compared with the annual costs before KT. We identified and characterized patients in three cost groups made of 2.9% in low-cost (LC), 51.8% in medium-cost (MC) and 45.3% in high-cost (HC). Cost group membership did not change after KT. Comparing costs in each group before and after KT, we found that KT was associated with 17% mean annual cost reductions for the LC group, 24% for the MC group and 26% for the HC group. The HC group included patients more likely to have a higher comorbidity burden (Charlson comorbidity index ≥ 3). Conclusions KT was associated with reductions in annual health care costs in the short term, even after accounting for costs incurred during KT.

Estimated Impact of Deemed Consent Legislation for Organ Donation on Individuals With Kidney Failure: A Dynamic Decision Analytic Model

“…Also, studies have shown that kidney transplantation is associated with decreases in mean annual health care costs compared with dialysis. 11 This emphasizes that there are likely cost savings that accompany policy changes that result in a greater number of dialysis patients receiving a deceased donor kidney transplant. In contrast, if the policy leads to a reduction in the deceased donor kidney transplant rate, it will expectedly lead to a decrease in both QALYs and total LYs.…”

An ex-ante cost-utility analysis of the deemed consent legislation compared to expressed consent for kidney transplantations in Nova Scotia

“…The annual inpatient costs before and after KT and costs for insured physician services before and after KT varied by whether the patient received an organ from a deceased or a living donor (Table 1 ). We sourced these costs from a Canadian study [ 22 ].…”

Development of a consortium to examine organ donation legislative and system reforms: A report from the LEADDR consortium

“…LEADDR currently has multiple articles in various stages of publication: eleven published, one accepted, three under peer review, and nine publications in progress. 10,15,[21][22][23][24][25][26][27][28][29] Included in those projects is an ongoing interrupted time series evaluating the quantitative impact of legislative change on donation and transplantation rates. Intentionally, this data has not been reported at this time, based on experiences from other jurisdictions that the full impact of such a change often does not occur until three to five years post implementation.…”