Economic Evaluation in Kidney Transplantation
Ellison, Trevor Ashton
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ABSTRACT Objective: To identify gaps in the economic literature as it pertains to kidney transplantation in order to inform future research topics as well as to identify the most cost-effective national screening policy for high-infectious risk organ donors and the most cost-effective utilization of marginal quality donated kidneys. Methods: A scoping review was employed to review the economics and kidney transplantation literature in order to perform a research gaps analysis. A decision tree analysis was used to elucidate the most cost-effective high-infectious risk donor screening strategy and a Markov model was utilized to determine patient phenotypes that would benefit from marginal quality kidney donor organs as well as the costeffectiveness of accepting certain quality organs for specific patient phenotypes. Results: The scoping review identified 278 articles from 102 medical and economic journals with research gaps including patient-perspective, pediatrics, and structural/macroeconomic topics. The decision tree analysis found that Selected NAT with ELISA screening strategy was the most cost-effective with an $18,100 savings per QALY compared to the current screening practice (discarding the ELISA Only strategy as a strategy that would not be employed in real practice) . The Markov model identified a large number of patient phenotypes that benefited from high KDPI organ acceptance with increased survival and QALYs and decreased lifetime treatment costs. Conclusion: Evaluation of the literature related to economics in kidney transplantation afforded the opportunity to address directed research by identifying future research efforts based on formal gaps analysis. The scarcity of organs in transplantation offered a rich opportunity to explore the related economic concepts of individual welfare maximization, allocation efficiency, and cost-effective analysis of competing screening strategies. The results of this dissertation may have policy impacts regarding the funding of associated research and use of marginal quality donated kidneys for transplantation.