title: Cost-effectiveness of kidney transplantation from DCD in Italy.
abstract: BACKGROUND
  Kidney transplantation represents the best therapeutic option for patients with end-stage renal disease (ESRD), providing the best outcomes for survival, quality of life, and cost-effectiveness. To increase kidney donations, in 2007, the Italian IRCCS Policlinico San Matteo Foundation in Pavia designed and conducted Programma Alba, a protocol for organ donation after cardiac death (DCD). This study evaluated the costs and health outcomes of DCD transplantation and in all types of transplants compared with current clinical practice.
  
  
  METHODS
  A Markov-based model was used to assess costs and health outcomes for new ESRD patients for 2008 to 2013. A health care founder perspective was used. Data sources were the Italian National Institute of Statistics and the Lombardy Registry of Dialysis and Transplantation. A microcosting analysis was performed to calculate costs related to clinical pathways for DCD. We assessed costs, survival, quality-adjusted survival, and cost-effectiveness.
  
  
  RESULTS
  Changing the actual practice pattern for new patients with ESRD and increasing the availability of kidneys from DCD to 10 extra transplants per year will induce an incremental cost per quality-adjusted life-year of €4255. Increases in transplantation to reach an extra 10% by transplant type would result in reduced costs and increased patient survival and quality of life compared with the current scenario.
  
  
  CONCLUSIONS
  Our data show that increasing DCD transplants would result in a cost-effective policy to expand the kidney donor pool compared with current ESRD treatment patterns. Italian policies should make an effort to increase transplant rates to optimize cost-effectiveness in ESRD service supply.
authors.affiliation: CeRGAS, Università Commerciale Luigi Bocconi, Milan, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Cavallo
authors.affiliation: Unit of Nephrology, Dialysis, Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: vincenzo.sepe@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Sepe
authors.affiliation: Unit of Nephrology and Dialysis, Ospedale di Cernusco sul Naviglio, Cernusco sul Naviglio, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Conte
authors.affiliation: Unit of Transplantation Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Abelli
authors.affiliation: Unit of Transplantation Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ticozzelli
authors.affiliation: Intensive Care Unit 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bottazzi
authors.affiliation: Transplantation Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: P M
authors.initials: PM
authors.lastname: Geraci
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003643:Death; D005260:Female; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012042:Registries; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000191:economics*; D055815:Young Adult