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Consequences of Eliminating HLA‐B in Deceased Donor Kidney Allocation to Increase Minority Transplantation
Author(s) -
Mutinga Nzisa,
Brennan Daniel C.,
Schnitzler Mark A.
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.00802.x
Subject(s) - medicine , donation , kidney transplantation , transplantation , quality adjusted life year , human leukocyte antigen , propensity score matching , histocompatibility testing , cost effectiveness , demography , immunology , economics , antigen , economic growth , risk analysis (engineering) , sociology
HLA matching contributes to the disparity in Caucasian compared to minority kidney transplantation. HLA‐B locus matching was eliminated from kidney allocation to shift a projected 166 organs from Caucasians to minorities annually. This study estimated the economic and quality‐of‐life impact of this policy. Cost‐effectiveness analysis was performed using a Markov model. Data from the United States Renal Data System (USRDS) were used to estimate race‐specific outcomes, patient and graft survival, quality‐adjusted life years (QALYs) and medical costs in U.S. dollars. The greatest benefit is expected in African Americans, with expected savings of $7.5 million and 243 QALYs. Smaller cost and QALY benefits are seen in other minority groups. In Caucasians, a loss of $7.0 million and a decrease of 967 QALYs are expected with the shift of organs. Overall, this policy is expected to save $5400 for each QALY that is lost. The same increase in minority transplantation would be expected from increasing Caucasian donation rates by 5.5%, or African‐American donation by 29.0%, each producing large cost savings and QALY gains. Policies to increase minority transplants by increasing donation rates may prove more cost effective than the elimination of HLA‐B matching from deceased donor kidney allocation.