ECONOMIC COST OF EXPANDED CRITERIA DONORS IN CADAVERIC RENAL TRANSPLANTATION

Abstract

7 The use of expanded criteria donors (ECDs) in cadaveric renal transplantation is increasing as the demand for organs continues to grow faster than the growth of supply. Here we assess the economic impact of the use of ECDs to the Medicare ESRD program, the most common payer for renal transplantation. Methods: We merged the UNOS renal transplant registry to Medicare claims data for 42,868 cadaveric renal transplants performed between 1991 - 1996 using identifiers provided by the USRDS. An ECD met any of these conditions: age <5 or >55, nonheartbeating, or history of hypertension or diabetes. High-risk recipients (HRR) were age >60, and/or retransplant. The total of all payments (PMT) for all services, facilities and supplies made by Medicare for these patients were projected from the pre-transplant dialysis period and compared to actual transplant and post-transplant payments to determine the time to financial break-even of transplant versus dialysis. This is the point where the cumulative cost of transplantation becomes less than dialysis. A 5% interest rate was assumed in all calculations. Results: There were 33,669 non-HRR transplants, of which 8,259 (25%) were ECDs, and 9,199 HRR transplants, of which 2,476 (27%) were ECDs. The present value of payments, and break-even times are given below: (Table)Conclusions: The impact of ECDs on Medicare payments is most pronounced in high-risk recipients. However, cadaveric renal transplantation is a cost saving treatment strategy for the Medicare ESRD program regardless of high-risk recipient status or the use of ECDs. These findings strongly support the use of ECDs in cadaveric renal transplantation.Table