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Yousefi M, Rezaei S, Hajebrahimi S, Falsafi N, Keshvari-Shad F. Peritoneal dialysis vs. hemodialysis among patients with end-stage renal disease in Iran: which is more cost-effective? BMC Nephrol 2024; 25:85. [PMID: 38448887 PMCID: PMC10916316 DOI: 10.1186/s12882-024-03530-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND There is little economic evidence on different modalities among patients with end-stage renal disease (ESRD) in Iran. This study aimed to assess the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) among ESRD patients in Iran. METHODS From the health system perspective and with a 10-year time horizon, we conducted a cost-utility analysis based on a Markov model to compare three strategies of PD and HD [the second scenario (30% PD, 70% HD), the third scenario (50% PD, 50% HD) and the fourth scenario (70% PD, 30% HD)] among ESRD patients with the current situation (PD, 3% vs. HD, 97%) as the basic scenario (the first scenario) in Iran. Cost data for PD, HD and kidney transplantation were extracted from the medical records of 720 patients in the Health Insurance Organization (HIO) database. The Iranian version of the EQ-5D-5 L questionnaire was filled out through direct interview with 518 patients with ESRD to obtain health utility values. Other variables such as transition probabilities and survival rates were extracted from the literature. To examine the uncertainty in all variables included in the study, a probabilistic sensitivity analysis (PSA) was performed. TreeAge Pro 2020 software was used for data analysis. FINDINGS Our analysis indicated that the average 10-year costs associated with the first scenario (S1), the second scenario (S2), the third scenario (S3) and the fourth scenario (S4) were 4750.5, 4846.8, 4918.2, and 4989.6 million Iranian Rial (IRR), respectively. The corresponding average quality-adjusted life years (QALYs) per patient were 2.68, 2.72, 2.75 and 2.78, respectively. The ICER for S2, S3 and S4 scenarios was estimated at 2268.2, 2266.7 and 2266.7 per a QALY gained, respectively. The analysis showed that at a willingness-to-pay (WTP) threshold of 3,000,000,000 IRR (2.5 times the GDP per capita), the fourth scenario had a 63% probability of being cost-effective compared to the other scenarios. CONCLUSION Our study demonstrated that the fourth scenario (70% PD vs. 30% HD) compared to the current situation (3% PD vs. 97% HD) among patients with ESKD is cost-effective at a threshold of 2.5 times the GDP per capita (US$4100 in 2022). Despite the high cost of PD, due to its greater effectiveness, it is recommended that policymakers pursue a strategy to increase the use of PD among ESRD patients.
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Affiliation(s)
- Mahmood Yousefi
- National Center for Health Insurance Research, Tehran, Iran
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Niloofar Falsafi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Keshvari-Shad
- National Center for Health Insurance Research, Tehran, Iran.
- Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
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Pilecki T, Czarkowska-Pączek B, Lisik W, Nazarewski S, Pączek L. Impact of Blood Pressure on Risk of Graft Failure or Death Among Patients After Kidney Transplantation in a 10-Year Observational Period: A Single-Center Retrospective Analysis. Ann Transplant 2023; 28:e939472. [PMID: 37786245 PMCID: PMC10559831 DOI: 10.12659/aot.939472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension is a risk factor for graft failure and mortality among kidney transplant recipients (KTRs). The aim of the study was to examine blood pressure (BP) as a factor that contributes to graft failure or death during a 10-year observation period. MATERIAL AND METHODS The study group comprised 70 KTRs who were treated according to their clinical state. Data were collected at 1 month and 1 year after transplantation and included office and ambulatory BP monitoring (ABPM) BP values, eGFR, proteinuria, and BMI. During the observation period, 6 patients died, and 10 lost the graft, but not during the first year. RESULTS Office and ABPM BP values were within normal ranges and did not differ from each other. eGRF and BMI were higher at 1 year compared to 1 month after transplantation, and proteinuria decreased. Among those who died, DBP was lower compared to those of survivors with graft failure. Proteinuria and donor age were positively correlated with BP. CONCLUSIONS Monitoring of BP and adequate treatment of hypertension resulting in BP values within normal values among KTRs contribute to longer survival of the graft and recipient. Older donor age and proteinuria could predict post-transplant hypertension. Low diastolic BP of the recipient could increase the risk of death among KTRs. Despite the fact that ABPM is the blood pressure measurement method of choice, appropriate standard office measurement could also be used for BP monitoring.
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Affiliation(s)
- Tomasz Pilecki
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | | | - Wojciech Lisik
- Chair and Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Sławomir Nazarewski
- Chair and Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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Miggins JJ, Reul RM, Barrett S, Rana A, Alnajar A, Dunson J, Shafii A, Garcha P, Goss J, Loor G. Twenty-year survival following lung transplantation. J Thorac Dis 2023; 15:2997-3012. [PMID: 37426158 PMCID: PMC10323557 DOI: 10.21037/jtd-22-1414] [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: 11/10/2022] [Accepted: 03/03/2023] [Indexed: 07/11/2023]
Abstract
Background Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival. Methods Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects. Results A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25-44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR) <10 mL/min, and donor GFR 20-29 mL/min. Conclusions This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.
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Affiliation(s)
| | - Ross M. Reul
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ahmed Alnajar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Miami, Miami, FL, USA
| | - Jordan Dunson
- Department of Orthopaedic Surgery, UT College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Alexis Shafii
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Puneet Garcha
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Loor
- Division of Cardiothoracic Transplantation and Circulatory Support, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Ghelichi-Ghojogh M, Mohammadizadeh F, Jafari F, Vali M, Jahanian S, Mohammadi M, Jafari A, Khezri R, Nikbakht HA, Daliri M, Rajabi A. The global survival rate of graft and patient in kidney transplantation of children: a systematic review and meta-analysis. BMC Pediatr 2022; 22:503. [PMID: 36002803 PMCID: PMC9404642 DOI: 10.1186/s12887-022-03545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background This study is a systematic review and meta-analysis on published studies about the Global Survival Rate of Graft and Patients in the Kidney Transplantation of children. Methods Studies that investigated the survival rate of kidney transplants published until the 30th of December 2020 were selected using a systematic search strategy in the following databases: Medline, Embase, Scopus, ProQuest, ISI Web of Science, and Cochrane. The extracted data were entered into the Excel software and STATA 16.0. The search identified 6007 study references. From the total, we excluded 1348 duplicates, 3688 reference titles and abstracts that were deemed irrelevant, and 846 references that were not original articles (i.e., letter, commentary, review) or did not meet the inclusion criteria. As such, 89 studies involving 12,330 participants were included in this meta-analysis. Results In this study 1, 3, 5, 7 and 10-year survival rates of graft were estimated to be 92, 83, 74.40, 67.10, and 63.50%, respectively. Also, 1, 3, 5, 7 and 10-year survival rates of patients were estimated to be 99.60, 97.30, 95.20, 74.60, and 97.90%, respectively. Conclusions The findings suggest differences in graft and patient survival among children with kidney transplants. Although differences in ethnic origin, incompatibility with deceased donor kidneys, and types of kidney disease are unavoidable, interventions to improve preventive and living-donor transplantation are particularly needed in minority groups. In addition, more research is needed to establish and address the contribution of medical and sociocultural barriers to preferential treatment of these groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03545-2.
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Affiliation(s)
- Mousa Ghelichi-Ghojogh
- Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Fatemeh Jafari
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mouhebat Vali
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Jahanian
- Department of Cardiovascular Surgery, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
| | - Masoud Mohammadi
- Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Jafari
- Department of Health Education and Health Promotion, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Rozhan Khezri
- Urmia Health center, Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Masumeh Daliri
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolhalim Rajabi
- Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran.
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Shajari A, Ashrafi MM, Shajari H, Derakhshan A. Graft and Patient Survival Rate among Iranian Pediatric Recipients of Kidney Transplantation: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:1232-1244. [PMID: 36447982 PMCID: PMC9659540 DOI: 10.18502/ijph.v51i6.9666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/25/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The End Stage Renal Disease (ESRD) is irreversible impairment of renal function, to the extent that the patient becomes permanently dependent on alternative therapies, especially in children. We aimed to evaluate the graft and patient survival rate among iranian pediatric recipients of kidney transplantation through a systematic review and meta-analysis. METHODS National (SID, MagIran, IranMedex, IranDoc) and international (Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science) databases of, were searched to find studies published electronically from 1985 until Nov 2019. Heterogeneity between the collected studies was determined using the Cochran's test (Q) and I2. Meta-regression was used to investigate the factors affecting statistical heterogeneity in 1, 5, and 10-year survival of kidney transplantation in addition to subgroup analysis based on cities. RESULTS Ten studies were qualified to enter the meta-analysis. The total participants in the study were 2673 people with an average age of 13.71±3.65 years. In the random-effects model, the survival rate of 1, 3, 5 and 10 yr of kidney transplantation were 91, 88, 81 and 70%, respectively. CONCLUSION By providing the documented and comprehensive evidence, can be the basis of many plans, policies, and decisions of various sectors of development. These sectors include the evaluation of treatment programs and health interventions in the pediatric kidney transplantation. The results of the present study can provide an acceptable estimate of the survival rate of transplanted children in Iran and will be useful for planning prevention and treatment programs.
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Affiliation(s)
- Ahmad Shajari
- Ali-Ebne-Abitaleb School of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran
| | - Mohammad Moein Ashrafi
- Young Researchers and Elites Club, Faculty of Medicine, Yazd Branch, Islamic Azad University, Yazd, Iran
| | - Hamideh Shajari
- Department of Neonatology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Derakhshan
- Shiraz Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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