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Nyokabi P, Youngkong S, Bagepally BS, Okech T, Chaikledkaew U, McKay GJ, Attia J, Thakkinstian A. A systematic review and quality assessment of economic evaluations of kidney replacement therapies in end-stage kidney disease. Sci Rep 2024; 14:23018. [PMID: 39362958 PMCID: PMC11450173 DOI: 10.1038/s41598-024-73735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 09/20/2024] [Indexed: 10/05/2024] Open
Abstract
End-stage kidney disease (ESKD) is fatal without treatment by kidney replacement therapies (KRTs). However, access to these treatment modalities can be problematic given the high costs. This systematic review (SR) aims to provide an updated economic evaluation of pairwise comparisons of KRTs and the implications for the proportion of patients with access to the KRT modalities, i.e., kidney transplantation (KT), hemodialysis (HD), and peritoneal dialysis (PD). This SR was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020. We searched studies in PubMed, Embase, Scopus, and Cost Effectiveness Analysis (CEA) registry, from inception to March 2023. Thirteen studies were included with pairwise comparisons among three KRTs, with varying proportions of patients for each modality. Seven studies were from high-income countries, including five from Europe. Summary findings are presented on a cost-effectiveness plane and incremental net benefit (INB). KT was the most cost-effective intervention across the pairwise comparisons. KT and PD were both more cost-effective alternatives to HD. HD was more costly and less effective than PD in all studies except one. Concurrent efforts to increase both KT and PD represented the best scenario to improve treatment options for ESKD patients.
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Affiliation(s)
- Patricia Nyokabi
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Ministry of Health, Nairobi, Kenya
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand.
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | | | - Tabitha Okech
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Ministry of Health, Nairobi, Kenya
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - John Attia
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Wu CC, Cao Y, Suen SC, Lin E. Examining chronic kidney disease screening frequency among diabetics: a POMDP approach. Health Care Manag Sci 2024; 27:391-414. [PMID: 38836923 PMCID: PMC11461555 DOI: 10.1007/s10729-024-09677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2024] [Indexed: 06/06/2024]
Abstract
Forty percent of diabetics will develop chronic kidney disease (CKD) in their lifetimes. However, as many as 50% of these CKD cases may go undiagnosed. We developed screening recommendations stratified by age and previous test history for individuals with diagnosed diabetes and unknown proteinuria status by race and gender groups. To do this, we used a Partially Observed Markov Decision Process (POMDP) to identify whether a patient should be screened at every three-month interval from ages 30-85. Model inputs were drawn from nationally-representative datasets, the medical literature, and a microsimulation that integrates this information into group-specific disease progression rates. We implement the POMDP solution policy in the microsimulation to understand how this policy may impact health outcomes and generate an easily-implementable, non-belief-based approximate policy for easier clinical interpretability. We found that the status quo policy, which is to screen annually for all ages and races, is suboptimal for maximizing expected discounted future net monetary benefits (NMB). The POMDP policy suggests more frequent screening after age 40 in all race and gender groups, with screenings 2-4 times a year for ages 61-70. Black individuals are recommended for screening more frequently than their White counterparts. This policy would increase NMB from the status quo policy between $1,000 to $8,000 per diabetic patient at a willingness-to-pay of $150,000 per quality-adjusted life year (QALY).
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Affiliation(s)
- Chou-Chun Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Yiwen Cao
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Eugene Lin
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
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D'Aragon F, Selzner M, Breau R, Masse MH, Lamontagne F, Masse M, Chassé M, Carrier FM, Cardinal H, Chaudhury P, Weiss M, Lauzier F, Turgeon AF, Frenette AJ, Bolduc B, Ducharme A, Lamarche C, Couture E, Holdsworth S, Bertholz L, Talbot H, Slessarev M, Luke P, Boyd JG, Shamseddin MK, Burns KEA, Zaltzman J, English S, Knoll G, Dhanani S, Healey A, Hanna S, Rochwerg B, Oczkowski SJW, Treleaven D, Meade M. Calcineurin Inhibitor in NEuRoloGically deceased donors to decrease kidney delayed graft function study: study protocol of the CINERGY Pilot randomised controlled trial. BMJ Open 2024; 14:e086777. [PMID: 38871657 PMCID: PMC11177676 DOI: 10.1136/bmjopen-2024-086777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Most solid organ transplants originate from donors meeting criteria for death by neurological criteria (DNC). Within the organ donor, physiological responses to brain death increase the risk of ischaemia reperfusion injury and delayed graft function. Donor preconditioning with calcineurin inhibition may reduce this risk. METHODS AND ANALYSIS We designed a multicentre placebo-controlled pilot randomised trial involving nine organ donation hospitals and all 28 transplant programmes in the Canadian provinces of Ontario and Québec. We planned to enrol 90 DNC donors and their approximately 324 organ recipients, totalling 414 participants. Donors receive an intravenous infusion of either tacrolimus 0.02 mg/kg over 4 hours prior to organ retrieval, or a matching placebo, while monitored in an intensive care unit for any haemodynamic changes during the infusion. Among all study organ recipients, we record measures of graft function for the first 7 days in hospital and we will record graft survival after 1 year. We examine the feasibility of this trial with respect to the proportion of all eligible donors enrolled and the proportion of all eligible transplant recipients consenting to receive a CINERGY organ transplant and to allow the use of their health data for study purposes. We will report these feasibility outcomes as proportions with 95% CIs. We also record any barriers encountered in the launch and in the implementation of this trial with detailed source documentation. ETHICS AND DISSEMINATION We will disseminate trial results through publications and presentations at participating sites and conferences. This study has been approved by Health Canada (HC6-24-c241083) and by the Research Ethics Boards of all participating sites and in Québec (MP-31-2020-3348) and Clinical Trials Ontario (Project #3309). TRIAL REGISTRATION NUMBER NCT05148715.
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Affiliation(s)
- Frederick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Markus Selzner
- Multi-Organ Transplant Program, Toronto General Hospital, Toronto, Quebec, Canada
- Department of General Surgery, University of Toronto and Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ruth Breau
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Hélène Masse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mélanie Masse
- Department of Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Chassé
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - François-Martin Carrier
- Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Héloïse Cardinal
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Prosanto Chaudhury
- Department of Surgery and Oncology, McGill University, Montreal, Québec, Canada
- Transplant Québec, Montréal, Québec, Canada
| | - Matthew Weiss
- Transplant Québec, Montreal, Québec, Canada
- Population Health and Optimal Health Practives Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Quebec, Canada
| | - Francois Lauzier
- Population Health and Optimal Health Practives Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Quebec, Canada
- Department of Medicine, Université Laval, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practives Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec - Université Laval, Quebec, Quebec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | | | - Brigitte Bolduc
- Department of Pharmacy, Centre integre universitaire de sante et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Anique Ducharme
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Montreal Heart Institute, Montreal, Québec, Canada
| | - Caroline Lamarche
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
- Hôpital Maisonneuve-Rosemont Research Institute, Montréal, Québec, Canada
| | - Etienne Couture
- Department of Anesthesiology and Critical Care, Quebec Heart & Lung Institute, Université Laval, Quebec, Quebec, Canada
| | - Sandra Holdsworth
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Liz Bertholz
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Heather Talbot
- Canadian Donation and Transplant Research Program, Edmonton, Alberta, Canada
| | - Marat Slessarev
- Department of Medicine, Division of Critical Care, Western University, London, Ontario, Canada
| | - Patrick Luke
- Department of Surgery, Division of Urology, Western University, London, Ontario, Canada
| | - John Gordon Boyd
- Department of Medicine, Division of Neurology, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - M Khaled Shamseddin
- Department of Medicine, Division of Nephrology, Queen's University, Kingston, Ontario, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, University Health Toronto - St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey Zaltzman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shane English
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Greg Knoll
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sonny Dhanani
- Department of Pediatrics, Division of Critical Care, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Healey
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven Hanna
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Darin Treleaven
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maureen Meade
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Maslauskiene R, Vaiciuniene R, Tretjakovs P, Gersone G, Radzeviciene A, Bura A, Stankevicius E, Bumblyte IA. Deceased Kidney Donor Biomarkers: Relationship between Delayed Kidney Function and Graft Function Three Years after Transplantation. Diagnostics (Basel) 2024; 14:717. [PMID: 38611630 PMCID: PMC11011901 DOI: 10.3390/diagnostics14070717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
With an increasing number of marginal donors, additional methods for the evaluation of cadaveric kidney quality are required. This study aimed to evaluate pretransplant deceased donor serum (s) and urine (u) biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), interleukin-18, and C-X-C motif chemokine 10 (CXCL10) for predicting early and late graft function. In total, 43 deceased kidney donors and 76 corresponding recipients were enrolled. Delayed graft function (DGF) occurred in 27.6% of cases. sIL-18, sKIM-1, uNGAL, and uKIM-1 were predictors of DGF. A model incorporating sIL-18, uKIM-1, and clinical factors was developed to predict DGF (AUROC 0.863). Univariate analysis showed a negative association between uKIM and graft eGFR at 6, 12, 24, and 36 months, but this was not confirmed in the multivariate analysis. In conclusion, we report a superior performance of donor biomarkers for predicting DGF and later graft function over serum creatinine. Higher levels of donor sIL-18 and uKIM in conjunction with expanded-criteria donors and longer cold ischemia times predicted DGF. With no renal tubular damage in zero-time donor biopsies, higher pretransplant urine and serum NGAL levels were associated with better allograft function one year after transplantation, and sNGAL with graft function three years after transplantation.
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Affiliation(s)
- Rima Maslauskiene
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
| | - Ruta Vaiciuniene
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
| | - Peteris Tretjakovs
- Department of Human Physiology and Biochemistry, Riga Stradins University, Dzirciema Str. 16, LV-1007 Riga, Latvia; (P.T.); (G.G.)
| | - Gita Gersone
- Department of Human Physiology and Biochemistry, Riga Stradins University, Dzirciema Str. 16, LV-1007 Riga, Latvia; (P.T.); (G.G.)
| | - Aurelija Radzeviciene
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (A.R.); (E.S.)
| | - Andrejus Bura
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
| | - Edgaras Stankevicius
- Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania; (A.R.); (E.S.)
| | - Inga Arune Bumblyte
- Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (R.V.); (A.B.); (I.A.B.)
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Rashidi MM, Saeedi Moghaddam S, Azadnajafabad S, Heidari-Foroozan M, Haddadi M, Sharifnejad Tehrani Y, Keykhaei M, Ghasemi E, Mohammadi E, Ahmadi N, Malekpour MR, Mohammadi Fateh S, Rezaei N, Mehrazma M, Larijani B, Farzadfar F. Burden and quality of care index of chronic kidney disease: Global Burden of Disease analysis for 1990-2019. Nephrol Dial Transplant 2024; 39:317-327. [PMID: 37587021 DOI: 10.1093/ndt/gfad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) imposes a heavy obscure burden on individuals and health systems. Besides its burden, the quality of care of CKD is less well investigated. In this study, we aimed to explore the global, regional and national trends of CKD burden and quality of care. METHODS The Global Burden of Disease Study 2019 data were used. Trends of incidence, prevalence, deaths and disability-adjusted life years were studied for the 1990-2019 period in the global aspect. By generating four secondary indices to assess different aspects of quality of care the quality of care index (QCI) was developed to explore the care provided for CKD. Inequities and disparities between various geographic, socio-demographic and age stratifications, and sex were studied using the QCI values. RESULTS In 2019, there were 18 986 903 (95% uncertainty interval 17 556 535 to 20 518 156) incident cases of CKD, globally. The overall global QCI score had increased slightly from 78.4 in 1990 to 81.6 in 2019, and it was marginally better in males (QCI score 83.5) than in females (80.3). The highest QCI score was observed in the European region with a score of 92.5, while the African region displayed the lowest QCI with 61.7. Among the age groups, the highest QCI was for children aged between 5 and 9 years old (92.0), and the lowest was in the age group of 20-24 year olds (65.5). CONCLUSIONS This study revealed that significant disparities remain regarding the quality of care of CKD, and to reach better care for CKD, attention to and care of minorities should be reconsidered. The evidence presented in this study would benefit health policymakers toward better and more efficient control of CKD burden alongside improving the care of this condition.
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Affiliation(s)
- Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Heidari-Foroozan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Center Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yeganeh Sharifnejad Tehrani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular Research Institute, Northwestern University, Chicago, IL, USA
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Mehrazma
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hryshchuk SM, Parii VD. Cost-effectiveness of dialysis and kidney transplantation to treat end-stage renal disease in Ukraine. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:765-771. [PMID: 38865635 DOI: 10.36740/wlek202404123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Aim: To determine the economic feasibility of using kidney transplantation compared to hemodialysis in end-stage renal disease in the long term in countries with a low and medium level of economic development using the example of Ukraine. PATIENTS AND METHODS Materials and Methods: The cost effectiveness analysis method was used. Conducted Markov modeling and comparison of the consequences of kidney transplantation and hemodialysis in terms of treatment costs and the number of added years of life for a cohort of 1,675 patients were carried out. The incremental cost-effectiveness ratio is defined. RESULTS Results: Based on the results of modeling, it was determined that among 1,675 patients with end-stage kidney disease in Ukraine, 1,248 (74.5%) will remain alive after 10 years of treatment when kidney transplantation technology is used. The highest costs will be in the first year ($25,864), and in subsequent years - about $5,769. With the use of hemodialysis technology, only 728 patients (43.5%) will be alive after 10 years, the cost of treating one patient per year is $11,351. The use of kidney transplantation adds 3191 years of quality life for 1675 patients compared with hemodialysis (1.9 years per patient). CONCLUSION Conclusions: Kidney transplantation is an economically feasible technology for Ukraine, as the incremental cost-effectiveness ratio is $4694, which is 1.04 times higher than Ukraine's GDP per capita. The results of the study allow us to recommend that decision-makers in countries with a low and medium level of economic development give priority in financing to renal transplantation.
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Affiliation(s)
- Serhii M Hryshchuk
- ZHYTOMYR IVAN FRANKO STATE UNIVERSITY, ZHYTOMYR, UKRAINE; ZHYTOMYR MEDICAL INSTITUTE, ZHYTOMYR, UKRAINE
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Hedley JA, Kelly PJ, Wyld M, Shah K, Morton RL, Byrnes J, Rosales BM, De La Mata NL, Wyburn K, Webster AC. Cost-effectiveness of Interventions to Increase Utilization of Kidneys From Deceased Donors With Primary Brain Malignancy in an Australian Setting. Transplant Direct 2023; 9:e1474. [PMID: 37090124 PMCID: PMC10118354 DOI: 10.1097/txd.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 04/25/2023] Open
Abstract
Kidneys from potential deceased donors with brain cancer are often foregone due to concerns of cancer transmission risk to recipients. There may be uncertainty around donors' medical history and their absolute transmission risk or risk-averse decision-making among clinicians. However, brain cancer transmissions are rare, and prolonging waiting time for recipients is harmful. Methods We assessed the cost-effectiveness of increasing utilization of potential deceased donors with brain cancer using a Markov model simulation of 1500 patients waitlisted for a kidney transplant, based on linked transplant registry data and with a payer perspective (Australian government). We estimated costs and quality-adjusted life-years (QALYs) for three interventions: decision support for clinicians in assessing donor risk, improved cancer classification accuracy with real-time data-linkage to hospital records and cancer registries, and increased risk tolerance to allow intermediate-risk donors (up to 6.4% potential transmission risk). Results Compared with current practice, decision support provided 0.3% more donors with an average transmission risk of 2%. Real-time data-linkage provided 0.6% more donors (1.1% average transmission risk) and increasing risk tolerance (accepting intermediate-risk 6.4%) provided 2.1% more donors (4.9% average transmission risk). Interventions were dominant (improved QALYs and saved costs) in 78%, 80%, and 87% of simulations, respectively. The largest benefit was from increasing risk tolerance (mean +18.6 QALYs and AU$2.2 million [US$1.6 million] cost-savings). Conclusions Despite the additional risk of cancer transmission, accepting intermediate-risk donors with brain cancer is likely to increase the number of donor kidneys available for transplant, improve patient outcomes, and reduce overall healthcare expenditure.
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Affiliation(s)
- James A. Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Patrick J. Kelly
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Melanie Wyld
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
| | - Karan Shah
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Juliet Byrnes
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Brenda M. Rosales
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nicole L. De La Mata
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kate Wyburn
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Renal Unit, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Angela C. Webster
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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8
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Yaghoubi M, Cressman S, Edwards L, Shechter S, Doyle-Waters MM, Keown P, Sapir-Pichhadze R, Bryan S. A Systematic Review of Kidney Transplantation Decision Modelling Studies. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:39-51. [PMID: 35945483 DOI: 10.1007/s40258-022-00744-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Genome-based precision medicine strategies promise to minimize premature graft loss after renal transplantation, through precision approaches to immune compatibility matching between kidney donors and recipients. The potential adoption of this technology calls for important changes to clinical management processes and allocation policy. Such potential policy change decisions may be supported by decision models from health economics, comparative effectiveness research and operations management. OBJECTIVE We used a systematic approach to identify and extract information about models published in the kidney transplantation literature and provide an overview of the status of our collective model-based knowledge about the kidney transplant process. METHODS Database searches were conducted in MEDLINE, Embase, Web of Science and other sources, for reviews and primary studies. We reviewed all English-language papers that presented a model that could be a tool to support decision making in kidney transplantation. Data were extracted on the clinical context and modelling methods used. RESULTS A total of 144 studies were included, most of which focused on a single component of the transplantation process, such as immunosuppressive therapy or donor-recipient matching and organ allocation policies. Pre- and post-transplant processes have rarely been modelled together. CONCLUSION A whole-disease modelling approach is preferred to inform precision medicine policy, given its potential upstream implementation in the treatment pathway. This requires consideration of pre- and post-transplant natural history, risk factors for allograft dysfunction and failure, and other post-transplant outcomes. Our call is for greater collaboration across disciplines and whole-disease modelling approaches to more accurately simulate complex policy decisions about the integration of precision medicine tools in kidney transplantation.
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Affiliation(s)
- Mohsen Yaghoubi
- Department of Pharmacy Practice, Mercer University College of Pharmacy, Atlanta, USA
| | - Sonya Cressman
- Faculty of Health Sciences, Simon Fraser University, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Louisa Edwards
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada
| | - Steven Shechter
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Paul Keown
- Department of Medicine, Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | | | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z3, Canada.
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P. K, J. VA, A. KB, S. B, K. K, J. D, J. WM, Tennankore KK. Estimated Impact of Deemed Consent Legislation for Organ Donation on Individuals With Kidney Failure: A Dynamic Decision Analytic Model. Can J Kidney Health Dis 2022; 9:20543581221139039. [PMID: 36452432 PMCID: PMC9703480 DOI: 10.1177/20543581221139039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND There is little data modeling the impact of deemed consent legislation (eligible individuals who do not register their decision to decline to be a donor are presumed to consent after death) on outcomes for individuals with kidney failure. OBJECTIVE To estimate the change in life-years (LYs) and quality-adjusted life-years (QALYs) resulting from different changes in the rate of deceased donor kidney transplantation associated with deemed consent legislation and health system transformation. DESIGN Dynamic Decision Analytic Model. SETTING This modeling study included kidney failure patients in Atlantic Canada (all of whom receive their kidney transplants in Halifax, Nova Scotia). The adoption of deemed consent legislation was the intervention, and opt-in (the status quo) was the reference comparator. PATIENTS Prevalent kidney failure patients at the end of 2019 in all of Atlantic Canada (N = 3615) served as the starting population. METHODS We compared expected outcomes between the intervention and comparator. Changes in QALYs and total LYs were modeled under different changes to the proportion of patients receiving a deceased donor kidney transplant (from -10% to 20%) resulting from deemed consent relative to the status quo. Changes in QALYs and LYs were reported for 3 different time horizons (5, 10, and 30 years). Uncertainty around QALYs and total LYs was reported using 95% confidence intervals (CIs) constructed from a probabilistic sensitivity analysis using 1000 Monte Carlo Simulations. RESULTS The increase in QALYs ranged from 7 QALYs (95% CI: 5-10) with a 5% increase using a 5-year time frame to 882 QALYs (95% CI: 619-1144) with a 20% increase over a 30-year time frame. Parallel changes in total LYs were also observed. In contrast, decreases in deceased donor kidney transplantation resulted in a loss of QALYs (for example, -463 QALYs; 95% CI: -633 to -306 for a 10% decrease over a 30-year time frame). Using the most optimistic scenario (a 20% increase), there was an 18% increase in the cumulative number of deceased donor kidney transplant recipients over a 30-year observation period. LIMITATIONS The results are subject to uncertainty depending on changes to the dialysis or transplant population that were not modeled and that may not be fully captured with probabilistic sensitivity analysis. CONCLUSIONS Deemed consent legislation will lead to variable changes in QALYs and total LYs for the kidney failure population, depending on the degree to which deceased donor transplantation rates change and the time horizon of observation. This modeling study may serve as a baseline to monitor the future impact of deemed consent legislation.
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Affiliation(s)
- Koto P.
- Nova Scotia Health, Halifax, Canada
| | - Vinson A. J.
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kiberd B. A.
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Beed S.
- Nova Scotia Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Krmpotic K.
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Dirk J.
- Nova Scotia Health, Halifax, Canada
| | - Weiss M. J.
- Department of Pediatrics, Université Laval, Quebec, QC, Canada
| | - Karthik K. Tennankore
- Nova Scotia Health, Halifax, Canada
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Koto P, Tennankore K, Vinson A, Krmpotic K, Weiss MJ, Theriault C, Beed S. An ex-ante cost-utility analysis of the deemed consent legislation compared to expressed consent for kidney transplantations in Nova Scotia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:55. [PMID: 36199099 PMCID: PMC9535887 DOI: 10.1186/s12962-022-00390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study was an ex-ante cost-utility analysis of deemed consent legislation for deceased organ donation in Nova Scotia, a province in Canada. The legislation became effective in January 2021. The study's objective was to assess the conditions necessary for the legislation change’s cost-effectiveness compared to expressed consent, focusing on kidney transplantation (KT). Method We performed a cost-utility analysis using a Markov model with a lifetime horizon. The study was from a Canadian payer perspective. The target population was patients with end-stage kidney disease (ESKD) in Atlantic Canada waitlisted for KT. The intervention was the deemed consent and accompanying health system transformations. Expressed consent (before the change) was the comparator. We simulated the minimum required increase in deceased donor KT per year for the cost-effectiveness of the deemed consent. We also evaluated how changes in dialysis and maintenance immunosuppressant drug costs and living donor KT per year impacted cost-effectiveness in sensitivity analyses. Results The expected lifetime cost of an ESKD patient ranged from $177,663 to $553,897. In the deemed consent environment, the expected lifetime cost per patient depended on the percentage increases in the proportion of ESKD patients on the waitlist getting a KT in a year. The incremental cost-utility ratio (ICUR) increased with deceased donor KT per year. Cost-effectiveness of deemed consent compared to expressed consent required a minimum of a 1% increase in deceased donor KT per year. A 1% increase was associated with an ICUR of $32,629 per QALY (95% CI: − $64,279, $232,488) with a 81% probability of being cost-effective if the willingness-to-pay (WTP) was $61,466. Increases in dialysis and post-KT maintenance immunosuppressant drug costs above a threshold impacted value for money. The threshold for immunosuppressant drug costs also depended on the percent increases in deceased donor KT probability and the WTP threshold. Conclusions The deemed consent legislation in NS for deceased organ donation and the accompanying health system transformations are cost-effective to the extent that they are anticipated to contribute to more deceased donor KTs than before, and even a small increase in the proportion of waitlist patients receiving a deceased donor KT than before the change represents value for money. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00390-z.
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Affiliation(s)
- Prosper Koto
- Research Methods Unit, Nova Scotia Health, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
| | - Karthik Tennankore
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS, Canada
| | - Amanda Vinson
- Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS, Canada
| | - Kristina Krmpotic
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Matthew J Weiss
- Centre Mère-Enfant Soleil du CHU de Québec, Transplant Québec, Québec, QC, Canada
| | - Chris Theriault
- Research Methods Unit, Nova Scotia Health, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Stephen Beed
- Department of Critical Care, Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Kiberd BA, Tennankore KK, Vinson AJ. Comparing the Net Benefits of Adult Deceased Donor Kidney Transplantation for a Patient on the Preemptive Waiting List vs a Patient Receiving Dialysis. JAMA Netw Open 2022; 5:e2223325. [PMID: 35867058 PMCID: PMC9308061 DOI: 10.1001/jamanetworkopen.2022.23325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Preemptive kidney transplantation is the preferred treatment for end-stage kidney disease. However, deceased donor (DD) kidneys are limited, and the net benefit of allocating kidneys to a preemptively waitlisted patient rather than to a patient receiving dialysis is unclear. OBJECTIVE To estimate the net benefit and costs of allocating kidneys to preemptively waitlisted patients vs those receiving dialysis. DESIGN, SETTING, AND PARTICIPANTS This medical decision analytical model used data from the 2020 US Renal Data System to calculate patient survival among waitlisted patients who received a DD kidney transplant. Four patients were simulated, with similar characteristics: (1) a patient on the preemptive waiting list receiving a DD transplant, (2) a patient on the preemptive waiting list never receiving a transplant, (3) a waitlisted patient already receiving dialysis (dialysis vintage <1 year) receiving a transplant, and (4) a waitlisted patient already receiving dialysis (dialysis vintage <1 year) never receiving a transplant. Annual probability of initiating dialysis (for patients 1 and 2) and duration of dialysis (for patients 3 and 4) were varied in sensitivity analyses. EXPOSURES Allocating a DD kidney to a patient on the preemptive waiting list vs the same kidney to a patient receiving dialysis for less than 1 year, with similar recipient characteristics. MAIN OUTCOMES AND MEASURES Differences in projected quality-adjusted life-years (QALYs) and total costs. RESULTS In a simulated patient with a mean start age of 50 years (range, 30-64 years), the patient receiving a preemptive DD transplantation experienced 10.58 (95% CI, 10.36-10.80) QALYs, and the patient on the preemptive waiting list never transplanted experienced 6.83 (95% CI, 6.67-6.99) QALYs. The patient receiving DD transplantation after less than 1 year of dialysis experienced 10.33 (95% CI, 10.21-10.55) QALYs, and the patient receiving dialysis who remained on the waiting list experienced 6.20 (95% CI, 6.04-6.36) QALYs; allocating a DD kidney to the preemptive patient added 3.75 (95% CI, 3.57-3.93) QALYs, whereas allocating the kidney to the patient already receiving dialysis added 4.13 (95% CI, 3.92-4.31) QALYs. While the estimated posttransplant survival was longest for the preemptive transplant recipient, preferentially allocating the kidney to the preemptive patient results in 0.39 (95% CI, 0.49-0.29) fewer QALYs. The net cost of preemptive transplantation was $54 100 (95% CI, $44 100-$64 100) more than transplantation to a waitlisted patient. If the rate of transitioning to dialysis was 20 (rather than 33) events per 100 patient waiting list-years, the net QALYs were -0.67 (95% CI, -0.78 to -0.56). If the patient was receiving dialysis for 3 to 4 years (vs <1 year) the net benefit was not significantly different; however, net costs were considerably higher for the preemptive option. CONCLUSIONS AND RELEVANCE In this decision analytic model study, although allocating DD kidneys to patients preemptively was the best option from a patient perspective, allocating DD kidneys to patients receiving dialysis was a better use of a scare resource from a societal perspective.
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Affiliation(s)
- Bryce A. Kiberd
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karthik K. Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda J. Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Wen J, Jin X, Al Sayah F, Short H, Ohinmaa A, Davison SN, Walsh M, Johnson JA. Mapping the Edmonton Symptom Assessment System-Revised: Renal to the EQ-5D-5L in patients with chronic kidney disease. Qual Life Res 2021; 31:567-577. [PMID: 34278540 DOI: 10.1007/s11136-021-02948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The Edmonton Symptom Assessment System-Revised: Renal (ESAS-r: Renal) is a disease-specific patient-reported outcome measure (PROM) that assesses symptoms common in chronic kidney disease (CKD). There is no preference-based scoring system for the ESAS-r: Renal or a mapping algorithm to predict health utility values. We aimed to develop a mapping algorithm from the ESAS-r: Renal to the Canadian EQ-5D-5L index scores. METHODS We used data from a multi-centre cluster randomized-controlled trial of the routine measurement and reporting of PROMs in hemodialysis units in Northern Alberta, Canada. In two arms of the trial, both the ESAS-r: Renal and the EQ-5D-5L were administered to CKD patients undergoing hemodialysis. We used data from one arm for model estimation, and data from the other for validation. We explored direct and indirect mapping models; model selection was based on statistical fit and predictive power. RESULTS Complete data were available for 506 patient records in the estimation sample and 242 in the validation sample. All models tended to perform better in patients with good health, and worse in those with poor health. Generalized estimating equations (GEE) and generalized linear model (GLM) on selected ESAS-r: Renal items were selected as final models as they fitted the best in estimation and validation sample. CONCLUSION When only ESAS-r: Renal data are available, one could use GEE and GLM to predict EQ-5D-5L index scores for use in economic evaluation. External validation on populations with different characteristics is warranted, especially where renal-specific symptoms are more prevalent.
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Affiliation(s)
- Jiabi Wen
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Xuejing Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Hilary Short
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michael Walsh
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, Hamilton, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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13
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Senanayake S, Graves N, Healy H, Baboolal K, Barnett A, Kularatna S. Time-to-event analysis in economic evaluations: a comparison of modelling methods to assess the cost-effectiveness of transplanting a marginal quality kidney. HEALTH ECONOMICS REVIEW 2021; 11:13. [PMID: 33856573 PMCID: PMC8051030 DOI: 10.1186/s13561-021-00312-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Economic-evaluations using decision analytic models such as Markov-models (MM), and discrete-event-simulations (DES) are high value adds in allocating resources. The choice of modelling method is critical because an inappropriate model yields results that could lead to flawed decision making. The aim of this study was to compare cost-effectiveness when MM and DES were used to model results of transplanting a lower-quality kidney versus remaining waitlisted for a kidney. METHODS Cost-effectiveness was assessed using MM and DES. We used parametric survival models to estimate the time-dependent transition probabilities of MM and distribution of time-to-event in DES. MMs were simulated in 12 and 6 monthly cycles, out to five and 20-year time horizon. RESULTS DES model output had a close fit to the actual data. Irrespective of the modelling method, the cycle length of MM or the time horizon, transplanting a low-quality kidney as compared to remaining waitlisted was the dominant strategy. However, there were discrepancies in costs, effectiveness and net monetary benefit (NMB) among different modelling methods. The incremental NMB of the MM in the 6-months cycle lengths was a closer fit to the incremental NMB of the DES. The gap in the fit of the two cycle lengths to DES output reduced as the time horizon increased. CONCLUSION Different modelling methods were unlikely to influence the decision to accept a lower quality kidney transplant or remain waitlisted on dialysis. Both models produced similar results when time-dependant transition probabilities are used, most notable with shorter cycle lengths and longer time-horizons.
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Affiliation(s)
- Sameera Senanayake
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Nicholas Graves
- Duke-NUS Medical School, 8 College road, Singapore, Singapore
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
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14
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Senanayake S, Graves N, Healy H, Baboolal K, Barnett A, Sypek MP, Kularatna S. Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices. BMC Health Serv Res 2020; 20:931. [PMID: 33036621 PMCID: PMC7547436 DOI: 10.1186/s12913-020-05736-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Matching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from 'longevity matching' on the Australian healthcare system. METHODS A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. RESULTS Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. CONCLUSION Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.
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Affiliation(s)
- Sameera Senanayake
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Nicholas Graves
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, SA, Australia
| | - Sanjeewa Kularatna
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
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