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More donors or more delayed graft function? A cost-effectiveness analysis of DCD kidney transplantation
Rebecca A Snyder1, Deonna R Moore, Derek E Moore
1Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
Insights
Utilizing donation after cardiac death (DCD) donors alongside donation after brain death (DBD) donors improves quality of life and reduces costs for transplant recipients. This strategy offers better outcomes compared to relying solely on DBD organs or remaining on dialysis.
Area of Science:
- Transplantation Medicine
- Health Economics
- Organ Donation
Background:
- Expanding the organ donor pool is crucial for transplantation.
- Donation after cardiac death (DCD) donors increase primary non-function and delayed graft function rates.
- Long-term outcomes for DCD and donation after brain death (DBD) donors are comparable.
Purpose of the Study:
- To evaluate the cost-effectiveness of incorporating DCD donors into organ wait lists.
- To compare patient and graft survival between DBD-only and combined DBD+DCD wait list strategies.
Main Methods:
- A Markov-based decision analytic model was developed.
- Simulated outcomes for two wait list strategies: DBD organs only vs. combined DBD and DCD organs.
- Data sourced from the Scientific Registry of Transplant Recipients (SRTR) and literature review; sensitivity analyses performed.
Main Results:
- The DBD-only strategy yielded 5.4 Quality-Adjusted Life Years (QALYs) at $65,000/QALY.
- The combined DBD+DCD strategy yielded 6.0 QALYs at a lower cost of $56,000/QALY.
- Wait lists including DCD donors demonstrated adequate long-term survival despite higher DGF rates.
Conclusions:
- Incorporating DCD donors enhances quality of life and decreases costs for transplant recipients.
- The combined DBD+DCD wait list strategy is more cost-effective than DBD-only.
- This approach offers significant benefits compared to prolonged dialysis treatment.
Abstract:
Expansion of the donor pool with expanded criteria donors and donation after cardiac death (DCD) donors is essential. DCD grafts result in increased rates of primary non-function (PNF) and delayed graft function (DGF). However, long-term patient and graft survival is similar between donation after brain death (DBD) donors and DCD donors. The aim of this study was to evaluate the cost-effectiveness of the use of DCD donors. A Markov-based decision analytic model was created to simulate outcomes for two wait list strategies: (i) wait list composed of only DBD organs and (ii) wait list combining DBD and DCD organs. Baseline values and ranges were determined from the Scientific Registry of Transplant Recipients (SRTR) database and literature review. Sensitivity analyses were conducted to test model strength and parameter variability. The wait list strategy consisting of DBD donors only provided recipients 5.4 Quality-adjusted life years (QALYs) at $65 000/QALY, whereas a wait list strategy combining DBD + DCD donors provided recipients 6.0 QALYs at a cost of $56 000/QALY. Wait lists with DCD donors provide adequate long-term survival despite more DGF. This equates to an improvement in quality of life and decreased cost when compared to remaining on dialysis for any period of time.
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