Kidney transplant (KT) from expanded criteria donors (ECD) have a higher rate of delayed graft function (DGF) that increases postoperative costs because of prolonged hospital stay, the need for dialysis and additional diagnostic procedures. Hypothermic machine perfusion (MP) has been shown to be superior to cold storage (CS) reducing the relative risks of DGF and primary non-function (PNF) and increasing one-year graft survival.
Hospital and Health Care System budget will be impacted by purchase of new technology.
To assess the short-term cost-effectiveness of ECD KT for the purpose of supporting the new preservation technology purchase, a probabilistic theoretical decision-tree was developed in 2011 that permitted to evaluate the costs and effects of KT in the postoperative period.The structure of the model was populated by historical data and actual outcomes of KT from ECD in our center from 01 January to 01 December. The model estimates budget impact and incremental cost-effectiveness ratio in terms of DGF and PNF cases.
Donor mean age was 73.1 years (CI95% 69.9-76.4). DGF rate decreased from 38.0 to 20.0%. DGF duration decreased from 6.5 to 4.0 days. The median hospital stay varied according to post-KT graft function from 8.0 days (6.0, 32.0) for recipients with IGF, to 9.0 days (6.0, 42.0) for DGF recipients. These results supposed a valuable decrease from those of CS preservation that were 12.0 (6.0, 63.0) days and 17.0 (7.0, 23.0) respectively. Resource consumption for CS stratified by graft function varied from $8,159 for immediate graft function (IGF) recipients, to $10,865 for DGF recipients to $25,933 for PNF recipients. Meanwhile, resource consumption for MP varied from $9,914 for IGF, to $12,005 for DGF. There were not PNF cases. The main components of resource consumption were hospitalization stay (38.0 47.5%) and immunosuppressive regimen (17.4 21.7%). The budget impact per patient for the introduction of MP was $267. However, the incremental cost-effectiveness ratio was $7,541 for each DGF and PNF saved cases.
The development of a probabilistic theoretical decision-tree in 2011 permitted to evaluate the costs and to justify the acquisition of hypothermic MP for ECD grafts.
To cite this abstract in AMA style:Gómez V, Diéz V, Galeano C, Gomis A, Hevia V, Jiménez M, Rodriguez-Patrón R, Arias F, Quereda C, Burgos F. Economic Impact of Pulsatile Hyothermic Perfusion in an Expanded Criteria Donor Transplant Program. Analysis of the First Year Implementation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/economic-impact-of-pulsatile-hyothermic-perfusion-in-an-expanded-criteria-donor-transplant-program-analysis-of-the-first-year-implementation/. Accessed May 9, 2021.
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