What are the short-term annual cost savings associated with kidney transplantation?

Cost Effectiveness and Resource Allocation

Matthew J. Weiss¹  Kristina Krmpotic²  Stephen Beed³  Karthik Tennankore⁴  Amanda Vinson⁴  Chris Theriault⁵  Prosper Koto⁵ 

[1] Centre Mère-Enfant Soleil du CHU de Québec, Transplant Québec;Department of Critical Care, Dalhousie University;Department of Critical Care, Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University;Department of Medicine (Division of Nephrology), Dalhousie University;Research Methods Unit, Nova Scotia Health;

关键词: Kidney transplantation;    High-cost;    Cost savings;    Cost-group;    Finite mixture model;   

DOI  :  10.1186/s12962-022-00355-2

来源: DOAJ

【 摘 要 】

Abstract Background Kidney transplantation (KT) is often reported in the literature as associated with cost savings. However, existing studies differ in their choice of comparator, follow-up period, and the study perspective. Also, there may be unobservable heterogeneity in health care costs in the patient population which may divide the population into groups with differences in cost distributions. This study estimates the cost savings associated with KT from a payer perspective and identifies and characterizes both high and low patient cost groups. Method The current study was a population-based retrospective before-and-after study. The timespan involved at most three years before and after KT. The sample included end-stage kidney disease patients in Nova Scotia, a province in Canada, who had a single KT between January 1, 2011, and December 31, 2018. Each patient served as their control. The primary outcome measure was total annual health care costs. We estimated cost savings using unadjusted and adjusted models, stratifying the analyses by donor type. We quantified the uncertainty around the estimates using non-parametric and parametric bootstrapping. We also used finite mixture models to identify data-driven cost groups based on patients’ pre-transplantation annual inpatient costs. Results The mean annual cost savings per patient associated with KT was $19,589 (95% CI: $14,013, $23,397). KT was associated with a 24–29% decrease in mean annual health care costs per patient compared with the annual costs before KT. We identified and characterized patients in three cost groups made of 2.9% in low-cost (LC), 51.8% in medium-cost (MC) and 45.3% in high-cost (HC). Cost group membership did not change after KT. Comparing costs in each group before and after KT, we found that KT was associated with 17% mean annual cost reductions for the LC group, 24% for the MC group and 26% for the HC group. The HC group included patients more likely to have a higher comorbidity burden (Charlson comorbidity index ≥ 3). Conclusions KT was associated with reductions in annual health care costs in the short term, even after accounting for costs incurred during KT.

【 授权许可】

Unknown