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. WONG^2,3

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.