Li, Bernadette, Cairns, John A., Johnson, Rachel J., Watson, Christopher J. E., Roderick, Paul, Oniscu, Gabriel C., Metcalfe, Wendy, Bradley, J. Andrew, Tomson, Charles R. , Draper, Heather, Forsythe, John L., Dudley, Christopher and Ravanan, Rommel (2020) Equity-efficiency trade-offs associated with alternative approaches to deceased donor kidney allocation : a patient-level simulation. Transplantation, 104 (4). pp. 795-803. doi:10.1097/TP.0000000000002910 ISSN 0041-1337.

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Abstract

Background: The number of patients waiting to receive a kidney transplant outstrips the supply of donor organs. We sought to quantify trade-offs associated with different approaches to deceased donor kidney allocation in terms of quality-adjusted life years (QALYs), costs and access to transplantation.

Methods: An individual patient simulation model was developed to compare five different approaches to kidney allocation, including the 2006 UK National Kidney Allocation Scheme (NKAS) and a QALY-maximisation approach designed to maximise health gains from a limited supply of donor organs. We used various sources of patient-level data to develop multivariable regression models to predict survival, health-state utilities and costs. We simulated the allocation of kidneys from 2200 deceased donors to a waiting list of 5500 patients and produced estimates of total lifetime costs and QALYs for each allocation scheme.

Results: Among patients who received a transplant, the QALY-maximisation approach generated 48,045 QALYs and cost £681 million while the 2006 NKAS generated 44,040 QALYs and cost £625 million. When also taking into consideration outcomes for patients who were not prioritised to receive a transplant, the 2006 NKAS produced higher total QALYs and costs and an incremental cost-effectiveness ratio of £110,741/QALY compared to the QALY-maximisation approach.

Conclusions: Compared to the 2006 NKAS, a QALY-maximisation approach makes more efficient use of deceased donor kidneys but reduces access to transplantation for older patients and results in greater inequity in the distribution of health gains between patients who receive a transplant and patients who remain on the waiting list.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	Transplantation
Publisher:	Lippincott Williams & Wilkins
ISSN:	0041-1337
Official Date:	April 2020
Dates:	Date Event April 2020 Published 8 August 2019 Available 23 July 2019 Accepted
Volume:	104
Number:	4
Page Range:	pp. 795-803
DOI:	10.1097/TP.0000000000002910
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	This is a non-final version of an article published in final form in Li, Bernadette, Cairns, John A., Johnson, Rachel J., Watson, Christopher J. E., Roderick, Paul, Oniscu, Gabriel C., Metcalfe, Wendy, Bradley, J. Andrew, Tomson, Charles R. , Draper, Heather, Forsythe, John L., Dudley, Christopher and Ravanan, Rommel (2019) Equity-efficiency trade-offs associated with alternative approaches to deceased donor kidney allocation : a patient-level simulation. Transplantation . doi:10.1097/TP.0000000000002910 (In Press)
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	23 July 2019
Date of first compliant Open Access:	8 August 2020
Related URLs:	Publisher

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