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[Costs of care in uremia. How much does kidney transplantation cost?]
A Jakobsen1, D Albrechtsen, G Sødal
1Kirurgisk avdeling B, Rikshospitalet, Oslo.
Insights
Kidney transplantation is significantly more cost-effective than long-term hemodialysis. Maintaining a high kidney transplant rate lowers overall healthcare expenditures and patient waiting lists.
Area of Science:
- Nephrology
- Health Economics
Background:
- Kidney transplantation and hemodialysis are critical treatments for end-stage renal disease.
- Understanding the comparative costs of these treatments is vital for healthcare resource allocation.
- Norway has historically maintained a high kidney transplantation rate.
Purpose of the Study:
- To compare the cost-effectiveness of kidney transplantation versus hemodialysis.
- To project national healthcare expenditures for end-stage renal disease treatment under different scenarios.
- To analyze the impact of transplantation rates on waiting lists and dialysis populations.
Main Methods:
- Cost analysis of kidney transplantation (tissue typing, surgery, hospitalization, first-year care, subsequent annual costs).
- Cost analysis of annual hemodialysis treatment.
- Modeling of national expenditures and waiting lists over a five-year period based on current and zero transplantation rates.
Main Results:
- Kidney transplantation yielded a cost-effectiveness of nearly NOK one million per patient over five years compared to dialysis.
- Annual hemodialysis costs were NOK 287,000 per patient, significantly higher than subsequent annual costs for transplant patients (NOK 70,000).
- A sustained high transplantation rate (42 per million) predicted total national expenditures of approx. NOK 400 million over five years, versus approx. NOK 750 million for dialysis alone if no transplants were performed.
Conclusions:
- Kidney transplantation is substantially more cost-effective than hemodialysis, offering significant savings.
- Norway's high transplantation rate effectively manages waiting lists and reduces the dialysis population compared to Western Europe.
- Maintaining high transplantation rates is crucial for controlling national healthcare expenditures for uremic patients.
Abstract:
The cost of kidney transplantation and hemodialysis have been recorded (in 1986). Tissue typing, operation and initial stay in hospital cost NOK 103,000 per patient, and further treatment for the first year after operation NOK 114,000. Subsequent annual costs were NOK 70,000, mainly for drugs. Hemodialysis costs NOK 287,000 per year. Transplantation was cost-effective by almost NOK one million per patient over a five-year period. If the current high national rate of transplantation (42 patients per million), which keeps both the national waiting list (23 patients per million) and the dialysis population at a low level, is sustained over the next five years, then total national expenditures for dialysis and transplantation are predicted to be approx. NOK 400 millions. If no transplants were performed during this period the waiting list would increase to 175 patients per million, and expenditures (for dialysis) to approx. NOK 750 millions. Additional huge investments would be needed in order to expand the facilities for dialysis. Because of high transplant rate, only 18 per cent of all treated uremics in Norway are now on dialysis, versus 73 per cent in Western Europe. Since transplantation is much cheaper than dialysis, national expenditures per treated patient are lower in Norway than in any other country.