Cost analysis of kidney transplantation in highly sensitized recipients compared to intermittent maintenance hemodialysis

Abstract

Kidney transplantation in allosensitized recipients has recently increased. Studies performing cost analysis of desensitization protocols are scarce. We performed an actual cost comparison between kidney transplantation following desensitization and maintenance hemodialysis. Group A (n=35) consisted of allosensitized recipients who underwent desensitization using immunoadsorption and/or plasmapheresis, intravenous immunoglobulin and anti-CD20 antibody who were followed for ≥ 2 years. Group B (n=49) consisted of matched patients who remained on hemodialysis throughout the study period. Actual costs of donor care, surgical procedures, out-patient visits, in-hospital admissions, medications, hemodialysis, immunoadsorption, plasmapheresis, and laboratory and radiology investigations were calculated. Health care services were provided by a single institution. Mortality rate was similar between both groups. The average 4-year actual total cost was $210,779 in group A and $317,186.3 in group B; respectively (p=0.017). Average total cost per patient in group A was $186,608; $14,233; $5,536; $4,402 in the first, second, third and fourth years after transplantation respectively while the average total annual cost per patient in group B was $79,296. The total cost in both groups became equal by month 31. The predicted annual cost savings in group A after 31 months was $33,943. Despite using costly desensitization protocols, kidney transplantation in sensitized patients provides long-term cost savings compared to maintenance hemodialysis.