Cost-effectiveness of transplanting older candidates with acceptable quality deceased donor kidneys

ImportanceMany acceptable quality deceased donor kidneys go unused every year. Older transplant candidates are more vulnerable to rapid health decline. ObjectiveTo assess the cost-effectiveness of increasing the rate of kidney transplantation in older patients with end-stage kidney disease by using acceptable quality deceased donor kidneys. DesignThis cost-effectiveness analysis utilizes a microsimulation model of the kidney transplantation process for older adult candidates over a lifetime horizon. SettingHealth state transition probabilities are derived from Scientific Registry of Transplant Recipient data. Costs and quality-of-life weights are derived from published literature and United States Renal Data System annual reports, all of which are varied in a probabilistic sensitivity analysis. ParticipantsA synthetic population of deceased donor kidney transplant candidates 65 or older. InterventionsIncreasing the rate of transplantation in 5% increments higher than the status quo rate from 5% to 25% using acceptable quality deceased donor kidneys. Main Outcomes and MeasuresThe primary outcomes are the number of key waitlist and post-transplant outcomes, costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs). ResultsWe estimated there would be 141 fewer waitlist deaths per 10,000 candidates if the rate of deceased donor transplantation were increased by 25% from the status quo rate. Increasing the rate of deceased donor transplantation by 25% costs $8,100 per QALY gained or is cost-saving from the healthcare sector and modified healthcare sector perspectives, respectively. From the healthcare sector perspective, a 25% increase in the rate of deceased donor transplantation is the preferred strategy in all probabilistic sensitivity analysis samples for willingness-to-pay thresholds [≥]$40,000 per QALY gained. Conclusions and RelevanceIncreasing the rate of kidney transplantation in older adults, even using acceptable quality deceased donor kidneys, would be cost-effective or cost-saving.