title: Modeling the benefits and costs of integrating an acceptable HLA mismatch allocation model for highly sensitized patients.
abstract: BACKGROUND
  The Eurotransplant acceptable mismatch program has improved transplantation access for highly sensitized recipients. However, the benefits and costs of implementing such a program remain unknown.
  
  
  METHODS
  Using decision analytical modeling, we compared the average waiting time for transplantation, overall survival gains (in life-years and quality-adjusted life-years gained), and costs of integrating an acceptable mismatch allocation model compared with the current deceased-donor kidney allocation model in Australia.
  
  
  RESULTS
  Acceptable mismatches were identified in 12 of 28 (43%) highly sensitized recipients using HLAMatchmaker. Inclusion of acceptable mismatches in the current allocation model improved the transplantation access for four (14%) highly sensitized recipients, with an average reduction in waiting time of 34 months (from 86 to 52 months). Compared with the current allocation model, incorporating an acceptable mismatch allocation model achieved an overall lifetime gain of 0.034 quality-adjusted life-years and savings of over $4,000 per highly sensitized patient, with a small consequential loss of 0.005 quality-adjusted life-years and extra costs of $800 for every reallocated patient.
  
  
  CONCLUSIONS
  Despite modest overall health gains, application of an acceptable mismatch allocation model is an equitable approach to improve transplantation access for highly sensitized transplant candidates without compromising the overall health benefits among the other patients on the deceased-donor waitlist in Australia.
authors.affiliation: 1 School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia. 2 Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia. 3 Sydney School of Public Health, The University of Sydney, Sydney, Australia. 4 Centre for Kidney Research, The Children's Hospital at Westmead & Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia. 5 Eurotransplant Reference Laboratory, Department Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands. 6 School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Australia. 7 Department of Clinical Immunology, Royal Perth Hospital, Perth, Australia. 8 Department of Renal Medicine, Royal Perth Hospital, Perth, Australia. 9 Department of Renal Medicine, Fremantle Hospital, Fremantle, Australia. 10 Address correspondence to: Hung Do Nguyen, M.D., School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6009, Australia.
authors.forename: Hung Do
authors.initials: HD
authors.lastname: Nguyen
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.forename: Frans H J
authors.initials: FH
authors.lastname: Claas
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Samantha
authors.initials: S
authors.lastname: Fidler
authors.forename: Lloyd
authors.initials: L
authors.lastname: D'Orsogna
authors.forename: Jeremey R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Ashley
authors.initials: A
authors.lastname: Irish
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrari
authors.forename: Frank T
authors.initials: FT
authors.lastname: Christiansen
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D008297:Male