title: Can donors with high donor risk indices be used cost-effectively in liver transplantation in US Transplant Centers?
abstract: In an effort to quantify the impact of donor risk factors on recipient outcomes, the donor risk index (DRI) was developed. A high DRI correlates with poorer post-transplant survival. In this study, high-DRI donors are classified as those having DRIs >2.0, while low-DRI donors have DRIs <2.0. The aim of this study was to evaluate the cost-effectiveness of high-DRI donor use in US Transplant Centers. A Markov-based decision analytic model was created to simulate outcomes for an allocation scheme using only low-DRI donors versus a scheme using both low- and high-DRI donors. Baseline values and ranges were determined from published data and Medicare cost data. Sensitivity analyses were conducted to test model strength and parameter variability. An allocation scheme in which only low-DRI donors were used generated 5.2 quality-adjusted life years (QALYs) at a cost of $83 000/QALY. An allocation scheme using both low- and high-DRI donors generated 5.9 QALYs at a cost of $66 000/QALY. Sensitivity analyses supported the use of an allocation scheme using both low- and high-DRI donors. The overall contribution of high-DRI grafts to the donor pool and the resultant reduction in wait-list mortality make them cost-effective.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Clark D
authors.initials: CD
authors.lastname: Kensinger
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Dageforde
authors.forename: Derek E
authors.initials: DE
authors.lastname: Moore
mesh_terms: D003362:Cost-Benefit Analysis; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics*; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics*; D014481:United States; D014850:Waiting Lists / Q000401:mortality
keywords: cost-effectiveness; donor risk index; liver transplant; quality-adjusted life years