F Escobar

Cost-utility analysis of living-donor kidney transplantation followed by pancreas transplantation versus simultaneous pancreas-kidney transplantation

For a type I diabetic with end‐stage renal disease, the choice between a kidney‐alone transplant from a living‐donor (KA–LD) and a simultaneous pancreas–kidney (SPK) transplant remains a difficult one. The prevailing practice seems to favor KA–LD over SPK, presumably due to the superior long‐term renal graft survival in KA–LD and the elimination of the lengthy waiting time on the cadaver transplant list. In this study, two treatment options, KA–LD followed by pancreas‐after‐kidney (PAK) and SPK transplant, are compared using a cost–utility decision analysis model. The decision tree consisted of a choice between KA–LD+PAK and SPK. The analysis was based on a 5‐yr model and the measures of outcome used in the model were cost, utility and cost–utility. The expected 5‐yr cost was

Prognostic factors and early resumption of cyclosporin A in renal allograft recipients with thrombotic microangiopathy and hemolytic uremic syndrome

277 638 for KA–LD+PAK and

Successful strategy for reducing biliary complications after liver transplantation

288 466 for SPK. When adjusted for utilities, KA–LD+PAK at a cost of

Benefit of angiotensin II receptor blockade in the treatment of posttransplant polycythemia in renal transplant recipients

153 911 was less cost‐effective than SPK at a cost of

Clinical and renal histologic predictors of long-term outcome after OKT3 therapy for steroid-resistant rejection

110 828 per quality‐adjusted year. One‐way sensitivity analyses were performed by varying patient and graft survival probabilities, utilities and cost. SPK remained the optimal strategy over KA–LD+PAK across all variations. Two‐way sensitivity analysis showed that in order for KA–LD+PAK to be at least as cost‐effective as SPK, 5‐yr pancreas and patient survival rates following PAK would need to surpass 86 and 80%. In conclusion, according to the 5‐yr cost–utility model presented in this study, KA–LD followed by PAK is less cost‐effective than SPK as a treatment strategy for a type I diabetic with end‐stage renal disease. For patients interested in the benefits of a pancreas transplant, it would be reasonable to offer SPK as the optimal treatment, even if a living kidney donor is available.