UBC Theses and Dissertations
Does high risk equal high cost? : a costing analysis of kidney transplantation in older patients Kadatz, Matthew James
Older patients with end-stage kidney disease have more comorbidities which can lead to complications following kidney transplantation and are more likely to receive a lower quality donor kidney. This analysis evaluates the association of donor kidney quality and recipient characteristics on health care costs in older kidney transplant recipients. The United States Renal Data Service database was used to establish a cohort of Medicare insured older individuals waitlisted for transplantation. Medicare payment data was used to determine the annual costs of care for patients from the perspective of Medicare as the health care payer. Generalized linear regression models were used to estimate the association between donor kidney quality and recipient comorbidities on cost pre- and post-transplantation. The mean cost of the first year of transplant ($99,115, 95% CI: $97,287 - $100,943) was higher than the average cost of dialysis in older patients ($92,283, 95% CI: $91,279 – $93,287), while subsequent years were lower cost ($32,341, 95% CI: $31,176 - $33,507). Lower donor quality, history of congestive heart failure, history of myocardial infarction, diabetes as the cause of kidney disease, and obesity were associated with increased incremental costs, and the association of these characteristics with cost varied over time following transplantation. The incremental cost associated with lower donor quality, age, history of myocardial infarction and history of congestive heart failure was highest in the first year following transplantation. Kidney transplantation may cost less than dialysis for older individuals that survive with kidney functions beyond the first year of transplantation. Patient and donor characteristics substantially impact the cost in older transplanted patients. A detailed cost-effectiveness analysis of kidney transplantation, which incorporates the risk of death and variation in outcomes with comorbidities in elderly patients, is warranted to guide optimal use of finite health care resources.
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