The CEA Registry Blog

Mar 8

by CEA Registry Team 3/8/2012 10:00 AM  RssIcon

Today is World Kidney Day.  Among other objectives, it promotes renal transplantation as the best procedure for treating kidney failure.  The Tufts CEA Registry provides evidence demonstrating that in the case of renal (kidney) transplantation, such life-saving procedures are also cost effective.  

Of the 26 cost-effectiveness ratios resulting from a Registry search for “renal transplantation,” there is strong uniformity among those comparing renal transplantation to dialysis supporting the cost-savings of renal transplantation, even across countries and disparate patient populations.  Transplantation led to both cost-savings and improvements in quality of life among Serbian patients diagnosed with chronic renal insufficiency, diabetes, hypertension, or polycystic kidney disease [1] as well as with end stage kidney disease patients in Greece [2], Germany [3] and Canada.[4]  A recent and prominent review of the costs and cost-effectiveness of interventions for chronic kidney disease found similar savings.[5]  

Unfortunately, human kidneys are a scarce resource, and patients’ family members may not be viable donors.  The United Network for Organ Sharing (UNOS) has constructed a system that allows donor altruism to overcome the biological hurdle of matching organs.  UNOS provides a network whereby people wishing to donate a kidney to someone with whom they are not a match agree to donate their kidney to a matched stranger if a match is found for their patient.[6]  In so doing, UNOS helps to align the incentives of individuals with the willingness to donate, but the inability to make a direct donation without a trusted third party.  These networks can be large; a recent organ swap in the US consisted of 60 individuals.  
 
As of March 7th, 2012, over 113,000 individuals are currently on the organ waiting list.[7]  World Kidney Day provides a good opportunity to both consider organ donation and to recognize how aligning incentives across disparate parties can result in better outcomes for all.  The network of paired kidney transplants offers an important example for clinicians, payers, and patients.  
 
by:  Michael J. Cangelosi
 
[1] Perovic, Sasa, Jankovic, Slobodan, Renal transplantation vs hemodialysis: cost-effectiveness analysis., Vojnosanit Pregl,2009-Aug; 66(8):639-44 PUBMED
[2] Kontodimopoulos, Nick, Kontodimopoulos, Nick, Niakas, Dimitris, An estimate of lifelong costs and QALYs in renal replacement therapy based on patients' life expectancy., Health Policy,2008-Apr; 86(1):85-96 PUBMED
[3] Roels, Leo, Boesebeck, Detlef, Kalo, Z, Whiting, James, Wight, Celia, Cost-benefit approach in evaluating investment into donor action: the German case.,Transpl Int,2003-May; 16(5):321-6 PUBMED
[4] Laupacis, A, Ferguson, B, Keown, P, Krueger, H, Muirhead, N, Pus, N, Wong, C, A study of the quality of life and cost-utility of renal transplantation., Kidney Int,1996-Jul; 50(1):235-42 PUBMED
[5]  Menzin J, Lines LM, Weiner DE, Neumann PJ, Nichols C, Rodriguez L, Agodoa I, Mayne T., A review of the costs and cost effectiveness of interventions in chronic kidney disease: implications for policy. Pharmacoeconomics. 2011-Oct;29(10):839-61. PUBMED
[6] UNOS Kidney Paired Donation (KPD) Program.  Available here 
[7]: UNOS Transplant Trends.  Available here, Accessed On: 2012-03-07.

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