The economic burden of kidney graft failure in the United States impacts patient survival and quality of life, and causes an increase in incremental health care spending, according to a published study.
“Despite the frequency of graft failures and the magnitude of the impact that it has on patients’ lives, its economic burden on society has not previously been estimated,” Jesse Sussell, associate director of policy and economies at Precision Health Economics and senior health economist at Genentech, and colleagues wrote. “Our study fills that gap.”
Researchers developed a state transition model (STM) that characterized the current status of kidney transplant patient experience. In the simulation, patients with functioning grafts were at risk for death and graft failure and those with failed grafts were at risk for death and return to the functioning graft state. Lifetime costs, overall survival and the quality-adjusted-life-years (QALYs) were estimated and the burden of graft failure was calculated.
Transitions through the model were estimated through the Scientific Registry of Transplant Recipients (SRTR) data. Cost and utility parameters were obtained through targeted literature review.
Researchers estimated the average survival gain resulting from the elimination of graft failure was 1.87 years or 1.66 QALYs. The estimation of discounted lifetime costs was $712,569 in the baseline for both those who experience graft failure and those who do not and $634,490 in the counter scenarios of the STM. According to the researchers, these results indicated eliminating graft failure would reduce the overall lifetime medical costs by an average of $78,079.
The SRTR registry showed 17,644 patients received kidney transplants in the United States in 2017. According to the researchers, the analysis suggested graft failure would create a total burden of $1.38 billion in incremental medical spending and a total QALY loss of 29,289.
In a rejection-specific model in which graft failure due to rejection is eliminated, the estimated survival gain across all patients at risk would be 0.81 years or 0.73 QALYs, according to the investigators. It was estimated that the graft failure due to rejection in the 2017 cohort would create a cumulative economic burden of $698 million and a loss of 12,880 QALYs.
These results suggested that, for the average patient, graft failure would create $78,079 additional medical costs and a loss of 1.66 QALYs, the researchers wrote.
“Our study is the first to estimate the economic burden of graft failure in the United States,” the researchers wrote. “We find that the burden is large across subgroups of interest and consists of both impacts on patient survival and quality of life, as well as increased incremental health care spending.”
According to the researchers, efforts to reduce kidney graft failure, as well as the impact caused by it, is urgently needed. – by Erin T. Welsh
Disclosures: Sussell reports being an employee at Precision Health Economics at the time of the study. Please see the study for other authors’ relevant financial disclosures.