*Purpose: Despite recent advances, graft failure imposes a substantial burden on kidney transplant recipients. This study is the first to quantify this burden in economic terms.

*Methods: We estimate economic burden (the total value of increased health spending and monetized quality adjusted life year [QALY] losses attributable to graft failure) using two versions of a model where simulated transplant recipients transition between health states. In the baseline version, patients were at risk for both graft failure and death. In the counterfactual version, risk of graft failure was set to zero. We estimated lifetime costs, survival, and QALYs for both versions and calculated the burden of graft failure as the difference between them. We used transplant registry data to estimate transition probabilities and obtained cost and utility parameters from the literature. All monetary values were inflated to 2018 USD.

*Results: When the risk of graft failure is set to zero, patients persist in the functioning graft state for a longer duration and experience an average survival gain of 2.2 years (Figure 1). We estimate the average burden of graft failure to be $213,583 per patient, largely due to reduced longevity and quality of life. With 17,644 kidney transplant recipients in 2017, we estimate the population economic burden of graft failure to be $3.77 billion (Table 1).

*Conclusions: The economic burden of graft failure is substantial and primarily due to impacts on longevity and quality of life. Efforts aimed at reducing graft failure may have significant clinical and economic impacts.

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