Equity-Efficiency Trade-offs Associated With Alternative Approaches to Deceased Donor Kidney Allocation: A Patient-level Simulation
| Autor: | Bernadette Li, Rachel J. Johnson, John Cairns, Christopher J.E. Watson, Christopher Dudley, John L. R. Forsythe, Gabriel C Oniscu, Rommel Ravanan, Heather Draper, Paul Roderick, J. Andrew Bradley, Wendy Metcalfe, Charles R.V. Tomson |
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| Přispěvatelé: | Watson, Christopher [0000-0002-0590-4901], Apollo - University of Cambridge Repository |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Waiting Lists Cost-Benefit Analysis Health Status 030230 surgery Risk Assessment Health Services Accessibility Donor Selection 03 medical and health sciences Young Adult 0302 clinical medicine Older patients Risk Factors medicine Humans Computer Simulation Healthcare Disparities Intensive care medicine Patient simulation Policy Making Deceased donor kidney Transplantation Deceased donor Equity (economics) Health Care Rationing business.industry Trade offs Age Factors Health Care Costs Original Clinical Science—General Middle Aged Kidney Transplantation Tissue Donors United States Kidney allocation Treatment Outcome ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Quality of Life 030211 gastroenterology & hepatology Female Quality-Adjusted Life Years business |
| Zdroj: | Transplantation |
| ISSN: | 0041-1337 |
| DOI: | 10.17863/cam.44300 |
| Popis: | Supplemental Digital Content is available in the text. Background. The number of patients waiting to receive a kidney transplant outstrips the supply of donor organs. We sought to quantify trade-offs associated with different approaches to deceased donor kidney allocation in terms of quality-adjusted life years (QALYs), costs, and access to transplantation. Methods. An individual patient simulation model was developed to compare 5 different approaches to kidney allocation, including the 2006 UK National Kidney Allocation Scheme (NKAS) and a QALY maximization approach designed to maximize health gains from a limited supply of donor organs. We used various sources of patient-level data to develop multivariable regression models to predict survival, health state utilities, and costs. We simulated the allocation of kidneys from 2200 deceased donors to a waiting list of 5500 patients and produced estimates of total lifetime costs and QALYs for each allocation scheme. Results. Among patients who received a transplant, the QALY maximization approach generated 48 045 QALYs and cost £681 million, while the 2006 NKAS generated 44 040 QALYs and cost £625 million. When also taking into consideration outcomes for patients who were not prioritized to receive a transplant, the 2006 NKAS produced higher total QALYs and costs and an incremental cost-effectiveness ratio of £110 741/QALY compared with the QALY maximization approach. Conclusions. Compared with the 2006 NKAS, a QALY maximization approach makes more efficient use of deceased donor kidneys but reduces access to transplantation for older patients and results in greater inequity in the distribution of health gains between patients who receive a transplant and patients who remain on the waiting list. |
| Databáze: | OpenAIRE |
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