1. A Cost-Effectiveness Analysis of Organ Preservation Methods for Deceased Donor Kidneys at High Risk for Delayed Graft Function in Brazil.
- Author
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Tedesco Silva H Jr, Evans RW, Gavaghan MB, and Vazquez VC
- Subjects
- Adult, Brazil, Cost-Benefit Analysis, Cryopreservation economics, Cryopreservation methods, Decision Trees, Delayed Graft Function economics, Delayed Graft Function physiopathology, Graft Survival, Humans, Incidence, Kidney Transplantation adverse effects, Kidney Transplantation methods, Middle Aged, Multicenter Studies as Topic, Organ Preservation methods, Perfusion economics, Perfusion methods, Prospective Studies, Quality of Life, Quality-Adjusted Life Years, Randomized Controlled Trials as Topic, Delayed Graft Function prevention & control, Kidney Transplantation economics, Organ Preservation economics
- Abstract
The clinical benefit of machine perfusion (MP) was recently assessed in a 1-year Brazilian multicenter prospective randomized trial, that showed that the use of MP was associated with a reduced incidence of delayed graft function (DGF) compared to static cold storage (SCS) in kidney transplant recipients (45% vs 61%). The objective of the present analysis is to consider the cost-effectiveness of MP relative to SCS based on clinical data from this Brazilian cohort. A decision tree model was constructed to simulate a population of 1000 kidney transplant recipients based on data derived from this Brazilian multicenter clinical trial. The model accounts for different health state utilities to estimate the cost-effectiveness of deceased donor kidney transplantation in Brazil comparing 2 kidney preservation methods: MP and SCS. The model accounts for 3 possible graft outcomes at 1 year post-transplantation: success (an immediate functioning kidney), failure (primary nonfunction requiring a return to dialysis), or DGF 1 year post-transplant. MP provided 612 total quality-adjusted life years (QALYs) (0.61 QALYs per patient) as compared to SCS (553 total QALYs, 0.55 QALYs per patient). MP was cost effective relative to SCS (US$22,117/QALY, R$70,606/QALY). The use of MP also resulted in more functioning grafts than SCS (821 vs 787), leading to a cost per functioning graft of US$38,033 (R$121,417). In conclusion, this analysis indicates that, despite the initial added cost associated with MP, the use of MP results in more functioning grafts (821 vs 787) and higher patient quality of life relative to SCS in Brazil., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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