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Heterotopic Renal Autotransplantation in a Porcine Model: A Step-by-Step Protocol
Published on: February 21, 2016
Kidney transplantation in the elderly: a decision analysis
Sarbjit V Jassal1, Murray D Krahn, Gary Naglie
1Division of Nephrology, University Health Network, Toronto, Ontario, Canada. vanita.jassal@uhn.on.ca
Journal of the American Society of Nephrology : JASN
|December 31, 2002
Summary
Kidney transplantation offers better life quality and expectancy for older patients with end-stage renal failure compared to dialysis. Timely access significantly improves clinical benefits and cost-effectiveness, highlighting the value of living donor programs.
Area of Science:
- Nephrology
- Transplantation Medicine
- Health Economics
Background:
- End-stage renal failure necessitates renal replacement therapy.
- Kidney transplantation offers improved outcomes over dialysis for younger patients.
- The cost-effectiveness of transplantation in older adults remains a critical consideration.
Purpose of the Study:
- To evaluate the cost-effectiveness of kidney transplantation versus dialysis in older patients.
- To model the economic and clinical benefits across different age groups and comorbidities.
- To identify factors influencing the value of transplantation in elderly renal failure patients.
Main Methods:
- A decision analytic model was developed comparing cadaveric kidney transplantation to hemodialysis.
- Models incorporated data on probability, utility, and survival from published reports and renal registries.
- Analyses were performed for various age groups (65, 70, 75+), comorbidities (diabetes, cardiovascular disease), and wait-list times.
Main Results:
- For 65-year-olds with a 2-year wait, transplantation yielded 1.1 additional quality-adjusted life years (QALYs) at $67,778 per QALY.
- Transplantation remained cost-effective for 70-year-olds (ICE $79,359/QALY) but less so for those over 75 or with comorbidities.
- Cost-effectiveness was highly sensitive to wait times, with prolonged waits diminishing benefits and increasing costs.
Conclusions:
- Kidney transplantation can provide substantial clinical benefits and economic value for older patients if accessed promptly.
- Prolonged waiting periods significantly reduce the attractiveness and benefits of transplantation.
- Living donor kidney transplantation may be particularly advantageous for older populations due to reduced wait times.
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