Resource use and treatment costs after kidney transplantation: impact of demographic factors, comorbidities, and complications.
BACKGROUND
Our goal was to quantify outcomes, resource use, and treatment costs for the first 2 years after renal transplantation in a "real-life" European setting and to assess the impact of preoperative risk factors and postoperative complications on treatment costs.


METHODS
Inpatient and outpatient records of all patients who received a renal transplant at Medizinische Hochschule Hannover, Germany, between January 1998 and July 2000, were evaluated. Key clinical events were recorded. Direct costs were calculated for primary hospitalization, the remainder of year 1, and year 2 after transplantation. Cost of organ procurement, pretransplant care, and transplant surgery were excluded. Cost consequences for key clinical events were determined.


RESULTS
Of 204 patients undergoing transplantation, 195 and 149 completed 1 year and 2 years of follow-up, respectively. The outcomes of years 1 and 2, respectively, were as follows: graft failure, 5.4%, 0.7%; acute rejection, 35.9%, 5.4%; cytomegalovirus (CMV) infection, 29.2%, 2.0%; and delayed graft function, 30.9%. Costs for primary hospitalization, the remainder of year 1, and year 2 averaged Euro 15,380, Euro 18,636, and Euro 14,484, respectively. Cost-driving events included graft failure Euro 36,228), acute rejection (Euro 9,638), delayed graft function (Euro7,359), and CMV infection (Euro 4,149). Graft failure and acute rejection for year 1 also added significantly to the costs for year 2.


CONCLUSIONS
These results show that posttransplant clinical outcomes result in a significant increase in treatment costs. Because the economic impact of primary causes of chronic rejection (acute rejection and CMV) and delayed graft function is substantial, careful selection of the most appropriate immunosuppressive regimen is essential.
Hagenmeyer
Ernst-Günther
EG
IGES Institut für Gesundheits-und Sozialforschung GmbH, Wichmannstr. 5, 10787 Berlin, Germany. hg@iges.de
Häussler
Bertram
B
Hempel
Elke
E
Grannas
Gerrit
G
Kaló
Zoltán
Z
Kilburg
Anne
A
Nashan
Björn
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000628:therapy; D003710:Demography; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000628:therapy; D012307:Risk Factors; D013997:Time Factors