title: Economic impact of the introduction of machine perfusion preservation in a kidney transplantation program in the expanded donor era: cost-effectiveness assessment.
abstract: BACKGROUND
  Kidney transplantations (KT) from expanded criteria donors (ECD) show a higher rate of delayed graft function (DGF) that increases postoperative costs because of the prolonged hospital stay as well as the needs for dialysis and additional diagnostic procedures. Hypothermic machine perfusion (MP) might be superior to cold storage (CS) to reduce the relative risks of DGF and primary nonfunction (PNF) as well as to increase 1-year graft survival.
  
  
  OBJECTIVE
  The aim of the study was to determine the relative cost-effectiveness of two different storage methods: MP versus CS.
  
  
  METHODS
  A probabilistic decision tree was developed to compare MP and CS as graft preservation methods. The structure of the model was populated by review of the literature and outcomes of KT from ECD in our center. The model estimated budget impact and incremental cost-effectiveness ratio in terms of DGF and PNF cases. The cost comparison of methods for KT preservation included: hospitalization and intermediate care unit stay; post-KT dialysis; graft removal; immunosuppressive regimen; treatment of acute rejection episodes; as well as costs of preservation solutions and pulsatile preservation device or storage containers.
  
  
  RESULTS
  Resource consumption for CS stratified by graft function varied from $8,159 for immediate graft function (IGF) recipients to $10,865 for DGF recipients to $25,933 for PNF recipients. Meanwhile, resource consumption for MP varied from $9,522 for IGF to $12,228 for DGF to $27,297 for PNF recipients. The main components of resource consumption were hospitalization stay (41.5%-53.9%); graft explantation (20.2%), and the need for dialysis (16.0%). The budget impact per patient for the introduction of MP was $505. However, the incremental cost-effectiveness ratio was $3,369 for each DGF- or PNF- saved case.
  
  
  CONCLUSIONS
  The introduction of the MP preservation technology in a KT program form ECD is cost-effective in terms of savings for DGF and PNF cases.
authors.affiliation: Urology Department, Ramón y Cajal University Hospital, Alcalá University, Madrid, Spain. vgomezd69@gmail.com
authors.forename: V
authors.initials: V
authors.lastname: Gómez
authors.forename: C
authors.initials: C
authors.lastname: Galeano
authors.forename: V
authors.initials: V
authors.lastname: Diez
authors.forename: C
authors.initials: C
authors.lastname: Bueno
authors.forename: F
authors.initials: F
authors.lastname: Díaz
authors.forename: F J
authors.initials: FJ
authors.lastname: Burgos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D046148:Donor Selection; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D017048:Health Care Costs; D006801:Humans; D007036:Hypothermia, Induced; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D018803:Models, Economic; D009926:Organ Preservation / Q000191:economics* / Q000295:instrumentation; D010477:Perfusion / Q000191:economics* / Q000295:instrumentation; D055031:Primary Graft Dysfunction / Q000209:etiology; D015397:Program Evaluation; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome