Kidney transplantation versus maintenance dialysis in 14 EU countries: cost savings, payback time, and budget impact

To assess the economic benefit and payback period of kidney transplantation compared to maintenance dialysis across 14 European Union countries (2019 and 2023), with a focus on living-donor transplantation.

A longitudinal country panel was compiled from European registry and national report. Cost-benefit analysis calculated annual net savings and break-even time, and cost-utility analysis estimated quality-adjusted life year gains using published utility weights with survival adjustment. A Graph-Regularized Neural Ordinary Differential Equations framework was introduced to capture nonlinear temporal dynamics and cross-country interactions, and its predictive performance was benchmarked compared against linear cost-benefit calculations and two-way fixed-effects regression using root mean squared error.

Transplantation was economically dominant in all country-years. Mean annual net savings were $37,471 and mean break-even time was 3.12 years (0.5-6.8). Incremental quality-adjusted life years averaged 4.38. Countries with living-donor share above 20% had shorter payback than those at or below 20% (2.01 vs. 4.28 years). The findings support the widespread economic superiority of transplantation over dialysis across the healthcare systems of all nations under investigation.

Living kidney transplantation consistently offers cost savings and health benefits across all health systems in the European Union. However, its scalability depends on country-specific payback periods, which are primarily influenced by upfront transplant costs.