McLaughlin Kevin, Manns Braden, Nickerson Peter
Division of Nephrology, University of Calgary, Calgary, Alberta, Canada.
Transplantation. 2006 May 15;81(9):1278-84. doi: 10.1097/01.tp.0000205797.05544.e5.
The economic and health benefits of kidney transplantation are dependent on the length of allograft survival. High-resolution immunological screening can identify recipients at increased risk of early graft loss caused by acute rejection, but the use of these tests increases screening costs before transplantation. The objective of this study was to evaluate the cost-effectiveness of routine use of high-resolution flow-cytometry cross-matching and solid-phase screening for all recipients of primary deceased donor kidney transplants.
A Markov model was constructed to evaluate costs and effects of two different clinical strategies on a simulated cohort of 1,000 transplant recipients: serological screening (SS) only and flow screening (FS) only. Outcomes measures were total cost of patient care over 25 years, life expectancy, quality-adjusted life expectancy, and transplant life expectancy.
In the base-case analysis, FS was associated with an average gain of 0.08 life years, 0.25 transplant life years, and 0.08 quality-adjusted life years per patient. SS was associated with a higher cost of CND$6,397 per patient, mostly because of increased use of dialysis in patients who suffered early graft loss under the SS strategy. The results were robust to uncertainty in the majority of variables, and a strategy using FS was cost-effective except under the unlikely scenario where the false-negative rate for SS was <or=2% or the early graft loss rate for flow-positive recipients was <or=7% (compared with 5% for flow-negative recipients).
Routine use of FS in recipients of first-deceased donor kidney transplants is cost-effective.
肾移植的经济和健康效益取决于同种异体移植物的存活时间。高分辨率免疫筛查可识别因急性排斥反应导致早期移植物丢失风险增加的受者，但这些检测的使用会增加移植前的筛查成本。本研究的目的是评估对所有初次接受死亡供体肾移植的受者常规使用高分辨率流式细胞术交叉配型和固相筛查的成本效益。
构建马尔可夫模型，以评估两种不同临床策略对1000名移植受者模拟队列的成本和效果：仅血清学筛查（SS）和仅流式筛查（FS）。结局指标为25年患者护理总成本、预期寿命、质量调整预期寿命和移植预期寿命。
在基础病例分析中，FS与每位患者平均增加0.08个生命年、0.25个移植生命年和0.08个质量调整生命年相关。SS与每位患者更高的成本6397加元相关，主要是因为在SS策略下早期移植物丢失的患者透析使用增加。结果对大多数变量的不确定性具有稳健性，除了在不太可能的情况下，即SS的假阴性率≤2%或流式阳性受者的早期移植物丢失率≤7%（流式阴性受者为5%）时，使用FS的策略具有成本效益。
对初次接受死亡供体肾移植的受者常规使用FS具有成本效益。
