Cost-benefit approach in evaluating investment into donor action: the German case.
Donor Action (DA) is an international initiative to help critical care units (CCUs) increase their own donation rates through improved-quality donation practices. Following a validated diagnostic review (DR), areas of weakness can be identified, and the appropriate changes introduced. Data gathered from a number of centers in nine European countries (including Germany) 1 year after the introduction of targeted improvement measures demonstrated a 59.2% (P=0.0015) increase in donation rates. This analysis computes the cost-benefit thresholds of implementing the DA methodology from a German health-economic point of view, taking into account the treatment alternatives for end-stage renal disease (dialysis and transplantation) and comparing the DA program with current organ-donation practice. Lifetime direct medical costs and quality-adjusted life years (QALYs) were calculated for both arms, considering only changes in cadaveric renal transplantation rates. If DA leads to a 59% overall increase in organ donation in Germany, the program will result in 33 QALYs and 1.8-million euro cost savings per million population (PMP). Therefore, DA would be cost-effective below 2.66-million euro implementation cost PMP (or 218-million euro for the whole country). As the partial implementation cost of the program was far below the threshold, DA is more cost-effective than other publicly reimbursed medical intervention.
Roels
Leo
L
Donor Action Foundation, Prinsendreef 10, 3210, Linden, Belgium. donoraction_lr@compuserve.com
Kalo
Zoltán
Z
Boesebeck
Detlef
D
Whiting
James
J
Wight
Celia
C
D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000191:economics*; D016030:Kidney Transplantation / Q000191:economics*; D011785:Quality Assurance, Health Care; D006435:Renal Dialysis / Q000191:economics; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000592:standards*; D014850:Waiting Lists