title: Cost-effectiveness of organ donation: evaluating investment into donor action and other donor initiatives.
abstract: Initiatives aimed at increasing organ donation can be considered health care interventions, and will compete with other health care interventions for limited resources. We have developed a model capable of calculating the cost-utility of organ donor initiatives and applied it to Donor Action, a successful international program designed to optimize donor practices. The perspective of the payer in the Canadian health care system was chosen. A Markov model was developed to estimate the net present value incremental lifetime direct medical costs and quality adjusted life years (QALYs) as a consequence of increased kidney transplantation rates. Cost-saving and cost-effectiveness thresholds were calculated. The effects of changing the success rate and time frame of the intervention was examined as a sensitivity analysis. Transplantation results in a gain of 1.99 QALYs and a cost savings of Can$104,000 over the 20-year time frame compared with waiting on dialysis. Implementation of an intervention such as Donor Action, which produced as few as three extra donors per million population, would be cost-effective at a cost of Can$1.0 million per million population. The cost-effectiveness of Donor Action and other organ donor initiatives compare favorably to other health care interventions. Organ donation may be underfunded in North America.
authors.affiliation: Maine Medical Center, Portland, ME, USA. whitij@mmc.org
authors.forename: James F
authors.initials: JF
authors.lastname: Whiting
authors.forename: Bryce
authors.initials: B
authors.lastname: Kiberd
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Kalo
authors.forename: Paul
authors.initials: P
authors.lastname: Keown
authors.forename: Leo
authors.initials: L
authors.lastname: Roels
authors.forename: Maria
authors.initials: M
authors.lastname: Kjerulf
mesh_terms: D002170:Canada; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000379:methods*