An economic assessment of contemporary kidney transplant practice
An economic assessment of contemporary kidney transplant practice
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DOI：
10.1111/ajt.14702
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发表时间：
2018-05-01
影响因子：
8.8
通讯作者：
Lentine, Krista L.
中科院分区：
文献类型：
--
作者：
Axelrod, David A.;Schnitzler, Mark A.;Lentine, Krista L.
肾移植是终末期肾病的最佳治疗方法，可延长生存期并减少费用。以前的经济分析肾移植，使用马尔可夫模型，一般假设兼容，低风险的捐助者。尚未评估高肾供者特征指数（KDPI）的已故供者、ABO血型不合的活体供者和HLA血型不合的活体供者移植的经济影响。移植和透析的成本与使用离散事件模拟在10年的时间内进行了比较，数据来自美国肾脏数据系统，大学健康系统联盟和文献综述。移植失败率和支出根据供体特征进行调整。与透析相比，所有移植选择均与生存率改善相关（移植：5.20-6.34质量调整生命年[Qs] vs透析：4.03 Qs）。与透析相比，活体供体和低KDPI死亡供体移植节省了成本，而使用高KDPI死亡供体、ABO不相容或HLA不相容的活体供体的移植具有成本效益（
Kidney transplantation is the optimal therapy for end-stage renal disease, prolonging survival and reducing spending. Prior economic analyses of kidney transplantation, using Markov models, have generally assumed compatible, low-risk donors. The economic implications of transplantation with high Kidney Donor Profile Index (KDPI) deceased donors, ABO incompatible living donors, and HLA incompatible living donors have not been assessed. The costs of transplantation and dialysis were compared with the use of discrete event simulation over a 10-year period, with data from the United States Renal Data System, University HealthSystem Consortium, and literature review. Graft failure rates and expenditures were adjusted for donor characteristics. All transplantation options were associated with improved survival compared with dialysis (transplantation: 5.20-6.34 quality-adjusted life-years [QALYs] vs dialysis: 4.03 QALYs). Living donor and low-KDPI deceased donor transplantations were cost-saving compared with dialysis, while transplantations using high-KDPI deceased donor, ABO-incompatible or HLA-incompatible living donors were cost-effective (