Evaluating multiple living kidney donor candidates simultaneously is more cost-effective than sequentially

Area of Science:

• Nephrology
• Transplant Surgery
• Health Economics

Background:

• Living donor kidney transplantation is crucial for patients with end-stage renal disease.
• Sequential evaluation of multiple living donor candidates can delay transplantation and prolong dialysis.
• Concurrent evaluation strategies may offer advantages but require cost-effectiveness analysis.

Purpose of the Study:

• To estimate the cost-effectiveness of simultaneously evaluating two to four living kidney donor candidates compared to sequential evaluation.
• To assess the impact of simultaneous evaluations on transplant timing, dialysis duration, and patient quality of life.

Main Methods:

• A decision tree model was used to simulate the costs and outcomes of simultaneous versus sequential living donor evaluations.
• The analysis considered healthcare system costs, averted dialysis costs, and quality-of-life gains.

Main Results:

• Simultaneous evaluation of two donor candidates incurred a small additional cost ($1,266 CAD) but resulted in earlier donation (one month sooner).
• This led to significant cost savings ($5,665 per recipient) due to averted dialysis costs ($6,931).
• Simultaneous evaluations increased living donor transplants by 1% and reduced dialysis initiation rates by 2% in specific scenarios, with similar benefits for three- and four-candidate evaluations.

Conclusions:

• Simultaneous evaluation of up to four living kidney donor candidates is cost-effective from a societal perspective.
• This approach offsets initial healthcare costs through substantial savings in avoided dialysis expenses.
• Implementing concurrent evaluations can improve transplant rates, reduce patient time on dialysis, and enhance overall quality of life.