title: Economic analysis of the treatment of end-stage renal disease treatment: living-donor kidney transplantation versus hemodialysis.
abstract: BACKGROUND
  End-stage renal disease (ESRD) is a major public health problem in the Spanish health system. Kidney transplantation is the treatment of choice, offering better survival and cost-effectiveness than other alternatives. This study aimed to compare the cost of living-donor kidney transplantation (LDKT) during the first year after transplantation with that of hemodialysis (HD).
  
  
  METHODS
  A prospective, descriptive study of cost and efficacy was performed in the Hospital Clinic in Barcelona from January to December 2011. We included 106 patients (57 undergoing HD and 49 receiving a LDKT). The costs of LDKT (donor and recipient) and HD were calculated based on our economic database program.
  
  
  RESULTS
  The mean age of recipients and donors was 46 ± 15 and 52 ± 10 years, respectively, and 67% of the recipients were men. In HD patients, the mean age was 67 ± 11 years and 62% were men. The total cost of LDKT was €29,897.91 (€8,128.44 for donors and €21,769.47 for recipients). The total cost of HD was €43,000.88 (€37,917 for HD and related procedures plus €5,082 for transport). LDKT represented a savings of €13,102.97 per patient/year and the payback period was less than 1 year. Quality-adjusted life years were higher in LDKT than in HD patients.
  
  
  CONCLUSIONS
  LDKT is cost effective during the first year after transplantation and is associated with enhanced quality of life. From both the medical and economic points of view, pre-emptive LDKD should be encouraged in Spain to reduce the health budget for ESRD.
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain. Electronic address: asanchee@clinic.ub.es.
authors: A
authors: A
authors: Sánchez-Escuredo
authors: Economic Nephrology Department, Hospital Clinic, Barcelona, Spain.
authors: A
authors: A
authors: Alsina
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: F
authors: F
authors: Diekmann
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: I
authors: I
authors: Revuelta
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: N
authors: N
authors: Esforzado
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: M J
authors: MJ
authors: Ricart
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: F
authors: F
authors: Cofán
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: J V
authors: JV
authors: Torregrosa
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: J M
authors: JM
authors: Campistol
authors: Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors: F
authors: F
authors: Oppenheimer
authors: Economic Nephrology Department, Hospital Clinic, Barcelona, Spain.
authors: E
authors: E
authors: Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D046148:Donor Selection / Q000191:economics*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000628:therapy*; D016030:Kidney Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics*; D013030:Spain