Abstract
Abstract Introduction Value-based practice is gaining traction as a way to control costs, improve patient satisfaction, and increase provider accountability. The rising prevalence of end-stage organ disease contrasts with limited donor organs, necessitating maximising equitable access, clinical outcomes, and appropriate cost control. We compare key kidney transplant metrics across the UK, US, and Canada. Methods Parameters analysed from the 2010–2022 national registries include: (1) Policy-components, (2) Transplant rates per million population; (3) 1-5 year survival, (4) Median waiting times, (5) Average cost per patient. Inequality was assessed using the Gini-index and concentration-curves. Results The UK NHS funded >1000 kidney-transplants in 2021 under standardised pricing and coordinated care. This enabled 98% one-year patient survival, 7 percentage points higher than in the US and Canada. The median kidney waiting time is 54% lower than in Canada. The UK transplantation rate per million increased by 25% over the decade, versus a 3% rise in the US and Canada. The Gini index is 0.03 in the UK, indicating highly equitable access, versus 0.11 in the US. Average transplant costs per patient are nearly 85% lower in the UK ($130,000) than in the US ($830,000). Conclusions The integrated funding and oversight model has facilitated access, survival, and sustainability gains on kidney transplantation for the UK NHS system versus lagging peer countries. Continued value optimisation remains necessary to tackle trade-offs. High-Level Structural Comparison ParameterUnited-KingdomUnited-StatesCanadaKey Payer(s)Single: NHSMedicare, Medicaid, PrivateSingle: Provincial-plansUse of Quality-MetricsYesPartialIn ProgressPricing ModelNational-TariffFragmentedProvincialRegulatory-OversightCentralizedVariableProvincial
Published Version
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