Evaluating Cost-Effectiveness in Using High-Kidney Donor Profile Index Organs.

Area of Science:

• Transplant Surgery
• Health Economics
• Biostatistics

Background:

• The Kidney Donor Profile Index (KDPI) offers a more detailed grading scale for donor kidneys than traditional frameworks.
• Evaluating the utility of high-KDPI kidneys is crucial for optimizing organ allocation and improving patient outcomes.

Purpose of the Study:

• To assess the survival, quality-adjusted life years (QALY), and cost-effectiveness of utilizing high-KDPI donor kidneys versus continued waiting list status.
• To identify patient and donor characteristics that predict benefits from accepting high-KDPI kidneys.

Main Methods:

• Development of a Markov decision process model simulating outcomes over a 60-month period.
• Utilized data from the Scientific Registry of Transplant Recipients and US Renal Data System Medicare databases.
• Classification and Regression Tree (CART) analysis to identify key drivers of improved outcomes.

Main Results:

• A significant majority of modeled phenotypes demonstrated benefits: 65% survival, 81% increased QALYs, 87% cost savings, and 76% cost savings per QALY from accepting high-KDPI kidneys.
• Key drivers for survival benefit included wait time ≥30 months, Panel Reactive Antibody (PRA) <90, age 45-65, specific renal failure diagnoses, and prior transplantation.
• Main drivers for QALY increase were wait time ≥30 months, PRA <90, and age 55-65.

Conclusions:

• Accepting high-KDPI donor kidneys can lead to substantial improvements in survival, QALYs, and cost-effectiveness for many patients on the kidney transplant waiting list.
• Strategic acceptance of higher-risk organs, guided by patient-specific factors and KDPI stratification, can optimize kidney allocation and transplant outcomes.