title: Cost analysis of kidney transplantation in highly sensitized recipients compared to intermittent maintenance hemodialysis.
abstract: BACKGROUND
  Kidney transplantation in allosensitized recipients has recently increased. Studies performing cost analysis of desensitization protocols are scarce.
  
  
  METHODS
  We performed an actual cost comparison between kidney transplantation following desensitization and maintenance hemodialysis. Group A (n=35) consisted of allosensitized recipients who underwent desensitization using immunoadsorption and/or plasmapheresis, intravenous immunoglobulin and anti-CD20 antibody who were followed for ≥ 2 years. Group B (n=49) consisted of matched patients who remained on hemodialysis throughout the study period. Actual costs of donor care, surgical procedures, out-patient visits, in-hospital admissions, medications, hemodialysis, immunoadsorption, plasmapheresis, and laboratory and radiology investigations were calculated. Health care services were provided by a single institution.
  
  
  RESULTS
  Mortality rate was similar between both groups. The average 4-year actual total cost was $210,779 in group A and $317,186.3 in group B; respectively (p=0.017). Average total cost per patient in group A was $186,608; $14,233; $5,536; $4,402 in the first, second, third and fourth years after transplantation respectively while the average total annual cost per patient in group B was $79,296. The total cost in both groups became equal by month 31. The predicted annual cost savings in group A after 31 months was $33,943.
  
  
  CONCLUSIONS
  Despite using costly desensitization protocols, kidney transplantation in sensitized patients provides long-term cost savings compared to maintenance hemodialysis.
authors.affiliation: Division of Pharmacy Services, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Jedai
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alsultan
authors.forename: Khalid
authors.initials: K
authors.lastname: Almeshari
authors.forename: Khalid
authors.initials: K
authors.lastname: Alshaibani
authors.forename: Hazem
authors.initials: H
authors.lastname: Elgamal
authors.forename: Delal
authors.initials: D
authors.lastname: Alkortas
authors.forename: Fowad
authors.initials: F
authors.lastname: Khurshid
authors.forename: Mai
authors.initials: M
authors.lastname: Altalhi
authors.forename: Khaled
authors.initials: K
authors.lastname: Hamawi
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006082:Graft Enhancement, Immunologic / Q000191:economics* / Q000379:methods; D006084:Graft Rejection / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use; D007155:Immunologic Factors / Q000191:economics / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D007518:Isoantibodies; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000191:economics* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000191:economics* / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D000069283:Rituximab; D012529:Saudi Arabia; D016060:Sorption Detoxification / Q000191:economics / Q000379:methods; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D000069283:Rituximab