Abstract
Kidney transplantation has been shown to offer superior outcomes over dialysis in the treatment of end-stage renal disease (ESRD). Medical technologies have been developed, aiming to overcome barriers often associated with (living) kidney transplantations (blood group incompatibility, highly sensitized patients). Immunoadsorption (IA) is one of these technologies. The analysis evaluates the cost-effectiveness of the therapy in patients undergoing incompatible kidney transplantation compared with remaining on treatment with dialysis. Quality-adjusted life years (QALY) and costs from a German health insurance perspective over a lifetime horizon were the primary outcome of the developed state-transition model. Additionally, the number of life years gained and the reduction of time in which the patients are dependent on dialysis have been part of the analysis. Current transplantation rates and potential future scenarios of increased incompatible transplantation rates enabled by IA have been analysed using various willingness-to-pay thresholds. A systematic review revealed a limited number of low quality studies on the effectiveness of IA. However, even when including high parameter uncertainty in sensitivity analyses, offering IA in incompatible kidney transplantations has been shown to be a dominant strategy with a probability of cost-effectiveness given a WTP of € 0 of 92,63 percent. IA might lead to an increase in QALYs per patient of 0,07; 0,1 and 0,25 for the base case analysis, scenario 1 and scenario 2, respectively, when increasing the number of incompatible transplantations. Cost reduction ranges between € 4.197,21 and € 15.505,58 resulting in overall cost savings of up to € 122.121.948,10 when extrapolating the findings to all waitlisted patients. Enabling incompatible living kidney transplantation in ESRD patients is a cost-effective approach resulting in better outcome at lower costs. An increase of the transplantation rate yields the opportunity of reduction of overall costs of renal replacement therapy for health care systems.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
