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More donors or more delayed graft function? A cost‐effectiveness analysis of DCD kidney transplantation
Author(s) -
Snyder Rebecca A.,
Moore Deonna R.,
Moore Derek E.
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12073
Subject(s) - medicine , donation , quality adjusted life year , dialysis , quality of life (healthcare) , waiting list , transplantation , kidney transplantation , surgery , cost effectiveness , risk analysis (engineering) , nursing , economics , economic growth
Expansion of the donor pool with expanded criteria donors and donation after cardiac death ( DCD ) donors is essential. DCD grafts result in increased rates of primary non‐function ( PNF ) and delayed graft function ( DGF ). However, long‐term patient and graft survival is similar between donation after brain death ( DBD ) donors and DCD donors. The aim of this study was to evaluate the cost‐effectiveness of the use of DCD donors. A Markov‐based decision analytic model was created to simulate outcomes for two wait list strategies: (i) wait list composed of only DBD organs and (ii) wait list combining DBD and DCD organs. Baseline values and ranges were determined from the Scientific Registry of Transplant Recipients ( SRTR ) database and literature review. Sensitivity analyses were conducted to test model strength and parameter variability. The wait list strategy consisting of DBD donors only provided recipients 5.4 Quality‐adjusted life years ( QALY s) at $65 000/ QALY , whereas a wait list strategy combining DBD + DCD donors provided recipients 6.0 QALY s at a cost of $56 000/ QALY . Wait lists with DCD donors provide adequate long‐term survival despite more DGF . This equates to an improvement in quality of life and decreased cost when compared to remaining on dialysis for any period of time.