Open AccessEffects of expanded allocation programmes and organ and recipient quality metrics on transplant‐related costs in kidney transplantation – an institutional analysis
Author(s) -
Dziodzio Tomasz,
Jara Maximilian,
Hardt Juliane,
Weiss Sascha,
Ritschl Paul Viktor,
Denecke Christian,
Biebl Matthias,
Gerlach Undine,
Reinke Petra,
Pratschke Johann,
Öllinger Robert
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13463
Subject(s) - medicine , transplantation , kidney transplantation , health care , kidney , healthcare system , kidney transplant , renal transplant , emergency medicine , intensive care medicine , urology , surgery , economics , economic growth
Summary Expansions of donor pools have a controversial impact on healthcare expenditures. The aim of this study was to investigate the emerging costs of expanded criteria donor (ECD) kidney transplantations (KT) and to identify independent risk factors for increased transplant‐related costs. We present a retrospective explorative analysis of hospital costs and reimbursements of KTs performed between 2012 and 2016 in a German university hospital. A total of 174 KTs were examined, including 92 (52.9%) ECD organ transplantations. The ECD group comprised 43 (24.7%) ‘old‐for‐old’ transplantations. Median healthcare costs were 19 570€ (IQR 18 735–27 405€) in the standard criteria donor (SCD) group versus 25 478€ (IQR 19 957–29 634€) in the ECD group (+30%; P = 0.076). ‘Old‐for‐old’ transplantations showed the highest healthcare expenditures [26 702€ (19 570–33 940€)]. Irrespective of the allocation group, transplant‐related costs increased significantly in obese (+6221€; P = 0.009) and elderly recipients (+6717€; P = 0.019), in warm ischaemia time exceeding 30 min (+3212€; P = 0.009) and in kidneys with DGF or surgical complications (+8976€ and +10 624€; both P < 0.001). Transplantation of ECD organs is associated with incremental costs, especially in elderly and obese recipients. A critical patient selection, treatment of obesity before KT and keeping warm ischaemia times short seem to be crucial, in order to achieve a cost‐effective KT regardless of the allocation group.