Fu Rui, Sekercioglu Nigar, Berta Whitney, Coyte Peter C
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Canadian Centre for Health Economics, Toronto, Ontario, Canada.
Transplant Direct. 2020 Jan 13;6(2):e522. doi: 10.1097/TXD.0000000000000974. eCollection 2020 Feb.
Deceased-donor renal transplant (DDRT) is an expensive and potentially risky health intervention with the prospect of improved life and lower long-term costs compared with dialysis. Due to the increasing shortage of kidneys and the associated rise of transplantation costs, certain patient groups may not benefit from transplantation in a cost-effective manner compared with dialysis. The objective of this systematic review was to provide a comprehensive synthesis of evidence on the cost-effectiveness of DDRT relative to dialysis to treat adults with end-stage renal disease and patient-, donor-, and system-level factors that may modify the conclusion. A systematic search of articles was conducted on major databases including MEDLINE, Embase, Scopus, EconLit, and the Health Economic Evaluations Database. Eligible articles were restricted to those published in 2001 or thereafter. Two reviewers independently assessed the suitability of studies and excluded studies that focused on recipients with age <18 years old and those of a living-donor or multiorgan transplant. We show that while DDRT is generally a cost-effective treatment relative to dialysis at conventional willingness-to-pay thresholds, a range of drivers including older patient age, comorbidity, and long wait times significantly reduce the benefit of DDRT while escalating healthcare costs. These findings suggest that the performance of DDRT on older patients with comorbidities should be carefully evaluated to avoid adverse results as evidence suggests that it is not cost-effective. Delayed transplantation may reduce the economic benefits of transplant which necessitates targeted policies that aim to shorten wait times. More recent findings have demonstrated that transplantation using high-risk donors may be a cost-effective and promising alternative to dialysis in the face of a lack of organ availability and fiscal constraints. This review highlights key concepts of health economic evaluations and the relevance of cost-effectiveness to inform care and decision-making in renal programs.
deceased-donor肾移植（DDRT）是一种昂贵且具有潜在风险的健康干预措施，与透析相比，有望改善生活质量并降低长期成本。由于肾脏短缺日益严重以及移植成本相应增加，与透析相比，某些患者群体可能无法以具有成本效益的方式从移植中获益。本系统评价的目的是全面综合关于DDRT相对于透析治疗终末期肾病成人的成本效益的证据，以及可能改变这一结论的患者、供体和系统层面的因素。我们在包括MEDLINE、Embase、Scopus、EconLit和健康经济评估数据库在内的主要数据库中对文章进行了系统检索。符合条件的文章仅限于2001年或之后发表的文章。两位评审员独立评估研究的适用性，并排除了关注年龄<18岁的受者以及活体供体或多器官移植的研究。我们发现，虽然在传统的支付意愿阈值下，DDRT相对于透析通常是一种具有成本效益的治疗方法，但包括患者年龄较大、合并症和等待时间较长等一系列因素会显著降低DDRT的益处，同时医疗成本不断上升。这些发现表明，应仔细评估DDRT对患有合并症的老年患者的疗效，以避免出现不良结果，因为有证据表明其不具有成本效益。移植延迟可能会降低移植的经济效益，这就需要制定旨在缩短等待时间的针对性政策。最近的研究结果表明，在器官供应不足和财政受限的情况下，使用高风险供体进行移植可能是一种具有成本效益且有前景的透析替代方案。本综述强调了健康经济评估的关键概念以及成本效益在为肾脏项目中的护理和决策提供信息方面的相关性。
