The routine use of high-resolution immunological screening of recipients of primary deceased donor kidney allografts is cost-effective.
BACKGROUND
The economic and health benefits of kidney transplantation are dependent on the length of allograft survival. High-resolution immunological screening can identify recipients at increased risk of early graft loss caused by acute rejection, but the use of these tests increases screening costs before transplantation. The objective of this study was to evaluate the cost-effectiveness of routine use of high-resolution flow-cytometry cross-matching and solid-phase screening for all recipients of primary deceased donor kidney transplants.


METHODS
A Markov model was constructed to evaluate costs and effects of two different clinical strategies on a simulated cohort of 1,000 transplant recipients: serological screening (SS) only and flow screening (FS) only. Outcomes measures were total cost of patient care over 25 years, life expectancy, quality-adjusted life expectancy, and transplant life expectancy.


RESULTS
In the base-case analysis, FS was associated with an average gain of 0.08 life years, 0.25 transplant life years, and 0.08 quality-adjusted life years per patient. SS was associated with a higher cost of CND$6,397 per patient, mostly because of increased use of dialysis in patients who suffered early graft loss under the SS strategy. The results were robust to uncertainty in the majority of variables, and a strategy using FS was cost-effective except under the unlikely scenario where the false-negative rate for SS was <or=2% or the early graft loss rate for flow-positive recipients was <or=7% (compared with 5% for flow-negative recipients).


CONCLUSIONS
Routine use of FS in recipients of first-deceased donor kidney transplants is cost-effective.
McLaughlin
Kevin
K
Division of Nephrology, University of Calgary, Calgary, Alberta, Canada. kevin.mclaughlin@calgaryhealthregion.ca
Manns
Braden
B
Nickerson
Peter
P
D002102:Cadaver; D002170:Canada; D003362:Cost-Benefit Analysis; D005434:Flow Cytometry; D006801:Humans; D007159:Immunologic Tests / Q000191:economics*; D016030:Kidney Transplantation / Q000191:economics / Q000276:immunology*; D008017:Life Expectancy; D014019:Tissue Donors; D016896:Treatment Outcome