The economic implications of HLA matching in cadaveric renal transplantation.
Publication/Presentation Date
11-4-1999
Abstract
BACKGROUND: The potential economic effects of the allocation of cadaveric kidneys on the basis of tissue-matching criteria is controversial. We analyzed the economic costs associated with the transplantation of cadaveric kidneys with various numbers of HLA mismatches and examined the potential economic benefits of a local, as compared with a national, system designed to minimize HLA mismatches between donor and recipient in first cadaveric renal transplantations.
METHODS: All data were supplied by the U.S. Renal Data System. Data on all payments made by Medicare from 1991 through 1997 for the care of recipients of a first cadaveric renal transplant were analyzed according to the number of HLA-A, B, and DR mismatches between donor and recipient and the duration of cold ischemia before transplantation.
RESULTS: Average Medicare payments for renal transplant recipients in the three years after transplantation increased from 60,436 dollars per patient for fully HLA-matched kidneys (those with no HLA-A, B, or DR mismatches) to 80,807 dollars for kidneys with six HLA mismatches between donor and recipient, a difference of 34 percent (P
CONCLUSIONS: Transplantation of better-matched cadaveric kidneys could have substantial economic advantages. In our simulations, HLA-based allocation of kidneys at the local level produced the largest estimated cost savings, when the duration of cold ischemia was taken into account. No additional savings were estimated to result from a national allocation program, because the additional costs of longer cold ischemia time were greater than the advantages of optimizing HLA matching.
Volume
341
Issue
19
First Page
1440
Last Page
1446
ISSN
0028-4793
Published In/Presented At
Schnitzler, M. A., Hollenbeak, C. S., Cohen, D. S., Woodward, R. S., Lowell, J. A., Singer, G. G., Tesi, R. J., Howard, T. K., Mohanakumar, T., & Brennan, D. C. (1999). The economic implications of HLA matching in cadaveric renal transplantation. The New England journal of medicine, 341(19), 1440–1446. https://doi.org/10.1056/NEJM199911043411906
Disciplines
Community Health and Preventive Medicine | Health Services Research | Medicine and Health Sciences
PubMedID
10547408
Department(s)
Department of Community Health and Health Studies
Document Type
Article