Dataset Information

Optimal patient selection for simultaneous heart-kidney transplant: A modified cost-effectiveness analysis.

ABSTRACT: Increasing rates of simultaneous heart-kidney (SHK) transplant in the United States exacerbate the overall shortage of deceased donor kidneys (DDK). Current allocation policy does not impose constraints on SHK eligibility, and how best to do so remains unknown. We apply a decision-analytic model to evaluate options for heart transplant (HT) candidates with comorbid kidney dysfunction. We compare SHK with a "Safety Net" strategy, in which DDK transplant is performed 6 months after HT, only if native kidneys do not recover. We identify patient subsets for whom SHK using a DDK is efficient, considering the quality-adjusted life year (QALY) gains from DDKs instead allocated for kidney transplant-only. For an average-aged candidate with a 50% probability of kidney recovery after HT-only, SHK produces 0.64 more QALYs than Safety Net at a cost of 0.58 more kidneys used. SHK is inefficient in this scenario, producing fewer QALYs per DDK used (1.1) than a DDK allocated for KT-only (2.2). SHK is preferred to Safety Net only for candidates with a lower probability of native kidney recovery (24%-38%, varying by recipient age). This finding favors the implementation of a Safety Net provision and should inform the establishment of objective criteria for SHK transplant eligibility.

SUBMITTER: Wayda B

PROVIDER: S-EPMC8983443 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Optimal patient selection for simultaneous heart-kidney transplant: A modified cost-effectiveness analysis.

Wayda Brian B Cheng Xingxing S XS Goldhaber-Fiebert Jeremy D JD Khush Kiran K KK

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20211130 4

Increasing rates of simultaneous heart-kidney (SHK) transplant in the United States exacerbate the overall shortage of deceased donor kidneys (DDK). Current allocation policy does not impose constraints on SHK eligibility, and how best to do so remains unknown. We apply a decision-analytic model to evaluate options for heart transplant (HT) candidates with comorbid kidney dysfunction. We compare SHK with a "Safety Net" strategy, in which DDK transplant is performed 6 months after HT, only if nat ...[more]

PMID: 34741786

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Project description:Rationale & objectiveNonadherence to medical regimens increases the risk of graft loss among adolescent and young adult recipients of kidney transplants. Interventions that improve adherence may decrease rejection rates, but their perceived costs are a barrier to clinical implementation. We developed a model to assess the cost-effectiveness of an adherence promotion strategy, the Medication Adherence Promotion System (MAPS).Study designSimulation-based. Data sources included published articles indexed in Medline or referenced in bibliographies of relevant English-language articles. Data on costs and outcomes were taken from a single clinical center.Setting & populationUS adolescent patients after their first kidney transplant.InterventionUsual posttransplant care versus usual care plus MAPS.OutcomeEffectiveness measured in quality-adjusted life years (QALYs) and costs measured in 2020 US dollars.Model, perspective, & timeframeMarkov state transition decision model. We used a health care system perspective with a lifelong time horizon.ResultsIn the base-case analysis, MAPS was more effective and less costly than usual care. MAPS cost $9,106 per patient less than usual care and resulted in a gain of 0.32 QALYs. In probabilistic sensitivity analyses, MAPS was cost saving 100% of the time. Extending results to a program level with 100 patients, any adherence promotion intervention similar in effectiveness to MAPS would cost less than $50,000/QALY if the start-up costs were <$2.5 million and annual costs <$188,000. Strategies with costs similar to MAPS that reduce the risk of rejection by as little as 3% would also have similar cost-effectiveness.LimitationsEstimates of components and costs for MAPS were based on a single center.ConclusionsAdherence promotion strategies with costs similar to MAPS can be cost-effective as long as they reduce rejection rates by at least 3%. This model can be applied to study the cost-effectiveness of adherence promotion strategies with varying costs and outcomes.

Dataset Information

Optimal patient selection for simultaneous heart-kidney transplant: A modified cost-effectiveness analysis.

Publications

Optimal patient selection for simultaneous heart-kidney transplant: A modified cost-effectiveness analysis.

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