title: Consequences of eliminating HLA-B in deceased donor kidney allocation to increase minority transplantation.
abstract: HLA matching contributes to the disparity in Caucasian compared to minority kidney transplantation. HLA-B locus matching was eliminated from kidney allocation to shift a projected 166 organs from Caucasians to minorities annually. This study estimated the economic and quality-of-life impact of this policy. Cost-effectiveness analysis was performed using a Markov model. Data from the United States Renal Data System (USRDS) were used to estimate race-specific outcomes, patient and graft survival, quality-adjusted life years (QALYs) and medical costs in U.S. dollars. The greatest benefit is expected in African Americans, with expected savings of US 7.5 million dollars and 243 QALYs. Smaller cost and QALY benefits are seen in other minority groups. In Caucasians, a loss of 7.0 million dollars and a decrease of 967 QALYs are expected with the shift of organs. Overall, this policy is expected to save US 5400 dollars for each QALY that is lost. The same increase in minority transplantation would be expected from increasing Caucasian donation rates by 5.5%, or African-American donation by 29.0%, each producing large cost savings and QALY gains. Policies to increase minority transplants by increasing donation rates may prove more cost effective than the elimination of HLA-B matching from deceased donor kidney allocation.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Nzisa
authors.initials: N
authors.lastname: Mutinga
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
mesh_terms: D001741:Black or African American; D002102:Cadaver; D003362:Cost-Benefit Analysis; D005006:Ethnicity; D015235:HLA-B Antigens / Q000378:metabolism*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods*; D008390:Markov Chains; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012042:Registries; D040841:Resource Allocation; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States; D044465:White People
chemical_list: D015235:HLA-B Antigens