Increasing the use of marginal kidneys in Manitoba’s older-adult end-stage renal disease population: survival and cost-utility implications

Kidney transplantation is the optimal treatment for patients with end-stage kidney disease, offering increased survival and reduced costs in comparison to dialysis. Transplant programs worldwide have increasingly relied upon organs from deceased donors to increase the supply of viable transplantable kidneys as current supply is unable to meet demand. The implications of transplantation with marginal kidneys, defined by a Kidney Donor Profile Index (KDPI) ≥86 from both an economic and patient survival perspective has not been assessed in the Canadian context. The purpose of this project is to describe the survival implications and cost-utility of increasing the use of marginal kidneys in Manitoba’s older-adult end-stage renal-disease patient population. We constructed a cost-utility model with microsimulation from the perspective of the Canadian single payer health system for incident transplant waitlisted patients aged 60 and over. Patients were followed for 10 years from date of waitlisting. We included Manitoba specific data pertaining to potential KDPI ≥86 kidney supply, transplant ineligibility, receiving a transplant, and death on the waitlist. Remaining model inputs were sourced from the literature. Our analysis compared the intervention (Marginal Kidney scenario) to usual care (Status Quo scenario). All costs are presented in 2019 Canadian dollars. The ten-year mean cost and quality-adjusted life years (QALYs) per patient in the Marginal Kidney scenario were estimated at $362,116.54 (SD: $149,037.69) and 4.52 (SD: 1.84). In the Status Quo scenario, the mean cost and QALYs per patient were estimated at $365,624.71 (SD: $152,647.93) and 4.35 (SD: 1.81). The incremental cost-utility ratio between the two scenarios was estimated at -$20,573.03. At ten years., 60.1% of the cohort in the Marginal Kidney scenario remained alive, compared to 56.7% in the Status Quo scenario. Mean survival for marginal kidney recipients and transplant-naïve patients were 115.59 and 80