THE BENEFITS AND COSTS OF SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION COMPARED WITH DIALYSIS AND KIDNEY-ALONE TRANSPLANTATION IN PATIENTS WITH TYPE 1 DIABETES MELLITUS AND END-STAGE KIDNEY DISEASE

R SHINGDE1, V CALISA1, JC CRAIG2, JR CHAPMAN3, AC WEBSTER3, H. PLEASS3, P O’CONNEL3L, R ALLEN3, P ROBERTSON3, L YUEN3, K KABLE3, B NANKIVELL3, N ROGERS3, G. WONG2,3

1Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead; 2Sydney School of Public Health, University of Sydney, Sydney; 3Centre for Transplant and Renal Research, Westmead Hospital, Westmead

Aim: To compare the absolute and relative health gains and costs of simultaneous pancreas kidney (SPK) with deceased donor kidney alone transplantation and dialysis in patients with type 1 diabetes mellitus (DM) and end-stage kidney disease (ESKD).

Background: The long-term costs and health benefits of SPK transplantation, compared to dialysis and deceased donor kidney alone transplant are unclear in this setting.

Methods: Two deterministic Markov models comparing patient survival in patients with Type I DM and ESKD who were either waitlisted on dialysis, received a SPK or deceased donor kidney alone transplantation were conducted (n = 10,000, aged 16-55). The model terminated when all patients died.

Results: Five-year survival for SPK, deceased donor kidney transplant and dialysis patients was 91%, 76% and 40% respectively. Compared to being on dialysis, the incremental health gains for SPK and deceased donor kidney alone transplant were 3.88 life years (LY) and 4.08 quality adjusted life years (QALY); 3.09 LY and 1.93 QALY, respectively. Compared to dialysis, the overall incremental cost-effectiveness ratio (ICER) for SPK and deceased donor kidney alone transplantation were 69,678 $/QALY and 98,428 $/QALY. Compared to deceased donor kidney alone transplant, the incremental health gains for SPK transplantation were 0.79 LY and 2.15 QALY, respectively. Using a series of one-way sensitivity analyses, the gains in life years and savings were most sensitive to the waiting time on dialysis. An increase in the waiting time incurred a greater risk of death.

Conclusions: SPK incurs the greatest benefits in life years and quality of life for type 1 DM patients with ESKD. SPK is also cost-effective compared to dialysis and deceased donor kidney transplantation alone.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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