The Relative Benefits and Costs of Luminex Testing for Preformed Donor Specific Anti-Human Leukocyte Antigen Antibodies in Kidney Transplantation.

Abstract

Background: Pre-transplant screening for donor specific antibodies (DSA) using the Luminex technology is now standard practice for many developed countries. However, the benefits and costs of Luminex as an add-on test to the CDC crossmatch remain unknown. Methods: Using decision analytical modelling, we compared the average health benefits (in rejection episodes prevented in the first year, grafts saved after five years and quality-adjusted life-years gained over the lifetime) and healthcare costs of using Luminex as an add-on test to the CDC crossmatch compared with the CDC crossmatch alone for identification of pre-transplant DSA. Results: In the base-case analyses, pre-transplant donor-specific antibody screening using Luminex as an add-on test to the CDC crossmatch compared with CDC crossmatch alone achieved incremental gains of 19 QALYs and savings of $1,029,666 per 100 transplants at a mean fluorescence intensity (MFI) threshold value of 500. Increasing the threshold value of MFI to 2000 yielded a comparatively small incremental gain of 17 QALYs and extra costs of $732,645. Using a series of sensitivity analyses, the choice of screening pre-transplant DSA using the Luminex technique was most sensitive to the false negative rate for antibody-mediated rejection in the setting of a negative Luminex test and the discount rates. Conclusions: Using a threshold value of 500, pre-transplant screening for DSA using the Luminex technique as an add-on test to the CDC achieved the greatest gain in longer-term health benefits and savings in kidney transplantation.