Chen Huey-Fen, Ali Hayatt, Marrero Wesley J, Parikh Neehar D, Lavieri Mariel S, Hutton David W
Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.
Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan.
MDM Policy Pract. 2021 Dec 6;6(2):23814683211063418. doi: 10.1177/23814683211063418. eCollection 2021 Jul-Dec.
There are several approaches such as presumed consent and compensation for deceased donor organs that could reduce the gap between supply and demand for kidneys. Our objective is to evaluate the magnitude of the economic impact of policies to increase deceased donor organ donation in the United States. We built a Markov model and simulate an open cohort of end-stage renal disease patients awaiting kidney transplantation in the United States over 20 years. Model inputs were derived from the United States Renal Data System and published literature. We evaluate the magnitude of the health and economic impact of policies to increase deceased donor kidney donation in the United States. Increasing deceased kidney donation by 5% would save $4.7 billion, and gain 30,870 quality-adjusted life years over the lifetime of an open cohort of patients on dialysis on the waitlist for kidney transplantation. With an increase in donations of 25%, the cost saved was $21 billion, and 145,136 quality-adjusted life years were gained. Policies increasing deceased kidney donation by 5% could pay donor estates $8000 or incur a onetime cost of up to $4 billion and still be cost-saving. Increasing deceased kidney donation could significantly impact national spending and health for end-stage renal disease patients.
有几种方法，如推定同意和对已故捐赠者器官的补偿，可缩小肾脏供需之间的差距。我们的目标是评估美国增加已故捐赠者器官捐赠政策的经济影响程度。我们构建了一个马尔可夫模型，并模拟了美国20年间等待肾脏移植的终末期肾病患者的开放队列。模型输入数据来自美国肾脏数据系统和已发表的文献。我们评估了美国增加已故捐赠者肾脏捐赠政策对健康和经济的影响程度。将已故肾脏捐赠增加5%，在等待肾脏移植的透析患者开放队列的一生中可节省47亿美元，并获得30870个质量调整生命年。捐赠增加25%时，节省的成本为210亿美元，获得了145136个质量调整生命年。将已故肾脏捐赠增加5%的政策可以向捐赠者遗产支付8000美元，或承担高达40亿美元的一次性成本，且仍能节省成本。增加已故肾脏捐赠会对终末期肾病患者的国家支出和健康产生重大影响。
