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Cost-effectiveness of Accepting Kidneys From Deceased Donors With Common Cancers-A Modeling Study
Karan K Shah1, James A Hedley2, Kristy P Robledo1
1Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Background:
The disparity between the demand for and supply of kidney transplants has resulted in prolonged waiting times for patients with kidney failure. A potential approach to address this shortage is to consider kidneys from donors with a history of common cancers, such as breast, prostate, and colorectal cancers.
Methods:
We used a patient-level Markov model to evaluate the outcomes of accepting kidneys from deceased donors with a perceived history of breast, prostate, or colorectal cancer characterized by minimal to intermediate transmission risk. Data from the Australian transplant registry were used in this analysis. The study compared the costs and quality-adjusted life years (QALYs) from the perspective of the Australian healthcare system between the proposed practice of accepting these donors and the conservative practice of declining them. The model simulated outcomes for 1500 individuals waitlisted for a deceased donor kidney transplant for a 25-y horizon.
Results:
Under the proposed practice, when an additional 15 donors with minimal to intermediate cancer transmission risk were accepted, QALY gains ranged from 7.32 to 20.12. This translates to an approximate increase of 7 to 20 additional years of perfect health. The shift in practice also led to substantial cost savings, ranging between $1.06 and $2.3 million.
Conclusions:
The proposed practice of accepting kidneys from deceased donors with a history of common cancers with minimal to intermediate transmission risk offers a promising solution to bridge the gap between demand and supply. This approach likely results in QALY gains for recipients and significant cost savings for the health system.
Insights
Accepting kidneys from deceased donors with common cancer histories can significantly increase transplant recipients' quality-adjusted life years (QALYs) and save millions in healthcare costs. This approach addresses the critical shortage of available organs for kidney failure patients.
Area of Science:
- Nephrology
- Transplantation Medicine
- Health Economics
Background:
- Significant disparity exists between kidney transplant demand and supply, leading to extended patient waiting times.
- Exploring utilization of kidneys from donors with histories of common cancers (breast, prostate, colorectal) presents a potential solution to organ scarcity.
Purpose of the Study:
- To evaluate the cost-effectiveness and quality-adjusted life years (QALYs) of accepting deceased donor kidneys from individuals with a history of common cancers.
- To compare a proposed practice of accepting these kidneys against the current conservative practice of declining them within the Australian healthcare system.
Main Methods:
- A patient-level Markov model was employed to simulate outcomes over a 25-year horizon for 1500 individuals on the kidney transplant waitlist.
- Data from the Australian transplant registry informed the model, focusing on donors with minimal to intermediate cancer transmission risk.
Main Results:
- Accepting an additional 15 donors with minimal to intermediate cancer transmission risk per year resulted in QALY gains of 7.32 to 20.12.
- This practice shift is projected to increase recipients' quality of life, equivalent to 7-20 additional years of perfect health.
- Significant cost savings for the Australian healthcare system were estimated between $1.06 and $2.3 million.
Conclusions:
- Accepting kidneys from deceased donors with a history of common cancers (minimal to intermediate risk) is a viable strategy to mitigate the organ shortage.
- This approach offers substantial benefits, including improved patient outcomes (QALY gains) and considerable economic advantages for the healthcare system.
