The cost-effectiveness of preservation with UW and EC solution for use in cadaveric kidney transplantation in the case of single kidney donors.
University of Wisconsin (UW) solution is now commonly used as a single-flush solution during multiorgan procurement for effective preservation of all intraabdominal organs including the kidney. Many kidneys from single kidney donors are still preserved in Eurocollins solution and the question is whether preservation in UW solution is more cost-effective. A European randomized multicenter trial was organized by the Department of Surgery of Leiden University in close cooperation with Eurotransplant to study the efficacy of UW solution as compared with EC solution. On the basis of this trial we found that at three months after transplant 92.4% of the patients in the UW group had a functioning graft in comparison with 88.4% in the EC group (similar figures after one year were 88.2% and 82.5%, P approximately 0.04), while health care expenditure during these first three months was on average US$ 700 lower for the UW group than for the EC group, taking into account the price difference in the preservation fluids. The long-term benefits of using UW solution as compared with EC solution were conservatively estimated at US$ 7000 per patient reflecting the additional expenses for dialysis in the EC group. We concluded that the extra costs of using UW solution instead of EC solution (US$ 230 per kidney) can be easily earned back within three months and that the long-term savings of such a strategy are considerable. Moreover, the health status of patients in the UW group is expected to be better on the average than in the EC group. Simply reacting to the price tag of the UW solution may be penny-wise but pound-foolish.
Rutten
F F
FF
Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands.
Ploeg
R J
RJ
McDonnell
J
J
Cohen
B
B
D000241:Adenosine / Q000191:economics; D000493:Allopurinol / Q000191:economics; D002102:Cadaver; D003362:Cost-Benefit Analysis; D005978:Glutathione / Q000191:economics; D006801:Humans; D006982:Hypertonic Solutions / Q000191:economics*; D007328:Insulin / Q000191:economics; D016030:Kidney Transplantation / Q000191:economics* / Q000502:physiology; D009426:Netherlands; D009926:Organ Preservation / Q000191:economics*; D019188:Organ Preservation Solutions; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics; D011887:Raffinose / Q000191:economics; D013997:Time Factors; D014019:Tissue Donors
C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose