Koto Prosper, Tennankore Karthik, Vinson Amanda, Krmpotic Kristina, Weiss Matthew J, Theriault Chris, Beed Stephen
Research Methods Unit, Nova Scotia Health, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
Department of Medicine (Division of Nephrology), Dalhousie University, Halifax, NS, Canada.
Cost Eff Resour Alloc. 2022 Oct 6;20(1):55. doi: 10.1186/s12962-022-00390-z.
This study was an ex-ante cost-utility analysis of deemed consent legislation for deceased organ donation in Nova Scotia, a province in Canada. The legislation became effective in January 2021. The study's objective was to assess the conditions necessary for the legislation change's cost-effectiveness compared to expressed consent, focusing on kidney transplantation (KT).
We performed a cost-utility analysis using a Markov model with a lifetime horizon. The study was from a Canadian payer perspective. The target population was patients with end-stage kidney disease (ESKD) in Atlantic Canada waitlisted for KT. The intervention was the deemed consent and accompanying health system transformations. Expressed consent (before the change) was the comparator. We simulated the minimum required increase in deceased donor KT per year for the cost-effectiveness of the deemed consent. We also evaluated how changes in dialysis and maintenance immunosuppressant drug costs and living donor KT per year impacted cost-effectiveness in sensitivity analyses.
The expected lifetime cost of an ESKD patient ranged from $177,663 to $553,897. In the deemed consent environment, the expected lifetime cost per patient depended on the percentage increases in the proportion of ESKD patients on the waitlist getting a KT in a year. The incremental cost-utility ratio (ICUR) increased with deceased donor KT per year. Cost-effectiveness of deemed consent compared to expressed consent required a minimum of a 1% increase in deceased donor KT per year. A 1% increase was associated with an ICUR of $32,629 per QALY (95% CI: - $64,279, $232,488) with a 81% probability of being cost-effective if the willingness-to-pay (WTP) was $61,466. Increases in dialysis and post-KT maintenance immunosuppressant drug costs above a threshold impacted value for money. The threshold for immunosuppressant drug costs also depended on the percent increases in deceased donor KT probability and the WTP threshold.
The deemed consent legislation in NS for deceased organ donation and the accompanying health system transformations are cost-effective to the extent that they are anticipated to contribute to more deceased donor KTs than before, and even a small increase in the proportion of waitlist patients receiving a deceased donor KT than before the change represents value for money.
本研究是对加拿大新斯科舍省已故器官捐赠的推定同意立法进行的事前成本效用分析。该立法于2021年1月生效。本研究的目的是评估与明示同意相比，该立法变革具有成本效益所需的条件，重点是肾移植（KT）。
我们使用具有终身期限的马尔可夫模型进行了成本效用分析。本研究是从加拿大支付方的角度进行的。目标人群是加拿大东部等待肾移植的终末期肾病（ESKD）患者。干预措施是推定同意及随之而来的卫生系统变革。明示同意（变革前）作为对照。我们模拟了为使推定同意具有成本效益每年已故供体肾移植所需增加的最低数量。我们还在敏感性分析中评估了透析和维持性免疫抑制药物成本以及每年活体供体肾移植的变化如何影响成本效益。
一名终末期肾病患者的预期终身成本在177,663美元至553,897美元之间。在推定同意环境下，每名患者的预期终身成本取决于等待名单上的终末期肾病患者在一年内接受肾移植比例的增加百分比。增量成本效用比（ICUR）随每年已故供体肾移植数量的增加而增加。与明示同意相比，推定同意具有成本效益至少需要每年已故供体肾移植数量增加1%。增加1%与每获得一个质量调整生命年（QALY）的增量成本效用比为32,629美元相关（95%置信区间：−64,279美元，232,488美元），如果支付意愿（WTP）为61,466美元，则具有成本效益的概率为81%。透析和肾移植后维持性免疫抑制药物成本超过阈值会影响性价比。免疫抑制药物成本的阈值还取决于已故供体肾移植概率的增加百分比和支付意愿阈值。
新斯科舍省已故器官捐赠的推定同意立法及随之而来的卫生系统变革具有成本效益是因为预期它们将比以前促成更多的已故供体肾移植案例发生，而且即使等待名单上接受已故供体肾移植的患者比例比变革前略有增加也代表具有性价比。
