Cost-Effectiveness of Hypothermic Machine Preservation Versus Static Cold Storage in Renal Transplantation
Cost-Effectiveness of Hypothermic Machine Preservation Versus Static Cold Storage in Renal Transplantation
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DOI：
10.1111/j.1600-6143.2012.04030.x
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发表时间：
2012-07-01
影响因子：
8.8
通讯作者：
Buskens, E.
中科院分区：
文献类型：
--
作者：
Groen, H.;Moers, C.;Buskens, E.
静态冷藏（CS）是死亡供肾移植物最广泛使用的器官保存方法，但越来越多的证据表明低温机器灌注（MP）可能会在移植后带来更好的结果。我们对 MP 与 CS 进行了经济评估，同时进行了多中心随机对照试验，调查短期和长期成本效益。包括三百三十六对连续肾脏，其中一对分配给 MP，一对分配给 CS。经济评估将基于研究经验数据的短期结果与10年时间范围的马尔可夫模型相结合。住院、透析治疗和并发症的直接医疗费用也包括在内。有关长期生存、生活质量和长期费用的数据来自文献。短期评估表明，MP 能以比 CS 更低的成本降低移植物功能延迟和移植物失败的风险。马尔可夫模型显示，MP 为每个生命年节省了 86 750 美元的成本。每增加一个质量调整生命年 (QALY)，相应的增量成本效用比为负 496 223 美元。我们得出的结论是，当通过 MP 而不是 CS 保存肾脏时，可以在获得生命年和 QALY 的同时降低成本。
Static cold storage (CS) is the most widely used organ preservation method for deceased donor kidney grafts but there is increasing evidence that hypothermic machine perfusion (MP) may result in better outcome after transplantation. We performed an economic evaluation of MP versus CS alongside a multicenter RCT investigating short- and long-term cost-effectiveness. Three hundred thirty-six consecutive kidney pairs were included, one of which was assigned to MP and one to CS. The economic evaluation combined the short-term results based on the empirical data from the study with a Markov model with a 10-year time horizon. Direct medical costs of hospital stay, dialysis treatment, and complications were included. Data regarding long-term survival, quality of life, and long-term costs were derived from literature. The short-term evaluation showed that MP reduced the risk of delayed graft function and graft failure at lower costs than CS. The Markov model revealed cost savings of $86 750 per life-year gained in favor of MP. The corresponding incremental cost-utility ratio was minus $496 223 per quality-adjusted life-year (QALY) gained. We conclude that life-years and QALYs can be gained while reducing costs at the same time, when kidneys are preserved by MP instead of CS.