Boston Healthcare Associates, Inc. (now a Veranex company), Boston, MA, USA.
Division of Nephrology, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
J Med Econ. 2022 Jan-Dec;25(1):515-523. doi: 10.1080/13696998.2022.2059221.
This study evaluates the economic impact to US commercial payers of MMDx-Kidney used in conjunction with histologic evaluation of for-cause kidney transplant biopsies.
An Excel-based model was developed to assess the cost impact of histology plus MMDx-Kidney versus histology alone for the evaluation of potential rejection in kidney transplant patients who receive a for-cause biopsy. Different model time periods were assessed, ranging from 1 to 5 years post-biopsy. A targeted literature review was used to identify parameter estimates, validated by two external clinicians with expertise in managing kidney transplant rejection. A sensitivity analysis was conducted to evaluate the relative impact of key clinical and cost parameters. In particular, the model identified the magnitude of MMDx-Kidney's impact on graft failure from rejection that would be required for MMDx-Kidney to be cost-neutral.
By more accurately characterizing rejection, MMDx-Kidney is estimated to increase antirejection treatment costs by $1,126 per test. Nevertheless, a break-even analysis shows that the costs of MMDx-Kidney and anti-rejection medication, as well as the costs associated with an increase in the number of patients with functioning transplants, may be offset by reductions in costs associated with graft failure (i.e. costs of hospitalizations, dialysis, and repeat transplants) over 5 years, assuming MMDx-Kidney reduces annual graft failure from rejection by at least 5%. For the base case, with a 25% relative reduction in annual rate of graft failures from rejection, MMDx-Kidney increases overall costs incurred in the first year of the model but starts generating savings by the second year of the model.
Compared with histologic evaluation of for-cause kidney transplant biopsies alone, the use of MMDx-Kidney in conjunction with histologic evaluation improves the diagnoses of graft dysfunction and may have the potential to generate overall savings from reductions in rejection-related graft failure.
本研究评估了 MMDx-Kidney 与活检时的组织学评估联合用于因病因进行的肾移植活检的美国商业支付者的经济影响。
使用基于 Excel 的模型来评估在接受因病因进行的活检的肾移植患者中，组织学加 MMDx-Kidney 与单独组织学相比对评估潜在排斥反应的成本影响。评估了不同的模型时间段，范围从活检后 1 到 5 年。进行了靶向文献综述以确定参数估计值，并由两位具有管理肾移植排斥反应专业知识的外部临床医生进行验证。进行了敏感性分析以评估关键临床和成本参数的相对影响。特别是，该模型确定了 MMDx-Kidney 对因排斥反应导致移植物衰竭的影响程度，这对于 MMDx-Kidney 达到成本中性至关重要。
通过更准确地描述排斥反应，MMDx-Kidney 估计每测试增加 1126 美元的抗排斥治疗费用。然而，盈亏平衡分析表明，MMDx-Kidney 和抗排斥药物的成本，以及与功能移植患者数量增加相关的成本，可能会因 5 年内与移植物衰竭相关的成本降低（即与住院治疗、透析和重复移植相关的成本）而得到弥补，假设 MMDx-Kidney 降低每年因排斥反应导致的移植物衰竭的比例至少为 5%。对于基础情况，每年因排斥反应导致的移植物衰竭率降低 25%，MMDx-Kidney 会增加模型第一年的总费用，但从第二年开始节省成本。
与单独进行活检时的组织学评估相比，在活检时的组织学评估中联合使用 MMDx-Kidney 可以改善移植物功能障碍的诊断，并且有可能通过降低与排斥反应相关的移植物衰竭而产生总体节省。
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