The cost implications of first anniversary renal function after living, standard criteria deceased and expanded criteria deceased donor kidney transplantation.
OBJECTIVE
To quantify relationships of post-transplant renal function with healthcare costs after kidney transplantation.


METHODS
Clinical and billing records for Medicare-insured kidney transplant recipients (1995-2003) were drawn from the US Renal Data System. Estimated glomerular filtration rate (eGFR) at 1-year post-transplant was computed with the abbreviated Modification of Diet in Renal Disease equation. Associations of eGFR with total Medicare payments in the second and third post-transplant years were examined by multivariate non-linear regression with spline forms. Adjustment covariates were drawn from the survival prediction model developed by the UNOS Kidney Allocation Review Committee.


RESULTS
The sample comprised 7103 living donor (LD), 22,110 standard criteria deceased (SCD), and 2594 expanded criteria deceased (ECD) donor transplant recipients. Regardless of donor type, lower 1-year eGFR was associated with significantly increased expenditures during the second and the third years post-transplant. Marginal costs began to increase as eGFR fell below 45 mL/min/1.73 m(2) and rose in an accelerating manner. Compared to a reference eGFR of 75 mL/min/1.73 m(2), 1-year eGFR of 20 ml/min/1.73 m(2) in SCD recipients was associated with ∼$17,500 and $18,200 higher adjusted payments in the second and third post-transplant years, respectively. Patterns were similar among recipients of LD and ECD transplants.


CONCLUSIONS
The study sample was limited to Medicare beneficiaries who survived with allograft function to the first transplant anniversary, which may limit generalizability of the findings. eGFR is a surrogate measure of renal function. The design is retrospective and changes in post-transplant management may alter long-term cost implication of renal function.


CONCLUSIONS
Decreased renal function is significantly associated with higher healthcare expenditures following kidney transplantation. Post-transplant eGFR may be a useful metric for discriminating the economic impact of care strategies that differentially affect renal function.
Center for Outcomes Research, Saint Louis University, MO, USA.
Mark A
MA
Schnitzler
Adrian
A
Gheorghian
David
D
Axelrod
Gilbert
G
L'Italien
Krista L
KL
Lentine
D000328:Adult; D000367:Age Factors; D005260:Female; D005919:Glomerular Filtration Rate; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D044469:Racial Groups; D012737:Sex Factors; D013997:Time Factors; D014019:Tissue Donors / Q000145:classification*; D014481:United States