Mr James Hedley1, Karan Shah2, Melanie Wyld1,3,4, Rachael Morton2, Juliet Byrnes1, Brenda Rosales1, Nicole De La Mata1, Patrick Kelly1, Kate Wyburn1,3, Angela Webster1,2,4
1Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Health and Medicine, University of Sydney, Camperdown, Australia, 2National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, 3Renal Unit, Royal Prince Alfred Hospital, Sydney, Australia, 4Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
Aim: To determine the cost-effectiveness of increasing utilization of kidneys from donors with brain cancer.
Background: Kidneys from potential deceased donors with brain cancer are often foregone due to concerns of cancer transmission risk to recipients. There may be uncertainty around donors’ medical history and their absolute transmission risk, or risk-averse decision-making among clinicians. However, brain cancer transmissions are rare and prolonging waiting time for recipients is harmful.
Methods: We assessed the cost-effectiveness of increasing utilization of these potential donors using a Markov model patient simulation with a payer perspective (Australian government) using linked transplant registry data. We estimated costs and quality-adjusted life-years (QALYs) for three interventions: decision support for clinicians in assessing donor risk; improved data accuracy with real-time data-linkage to hospital records and cancer registries; and increased risk-tolerance to allow intermediate-risk donors (6.4% potential transmission risk).
Results: Compared with current practice, decision support provided 0.3% more donors (2% transmission risk), and improved QALYs and saved costs (dominant) in 78% of simulations. Real-time data-linkage provided 0.6% more donors (1.1% average transmission risk) and was dominant in 80% of simulations. Increasing risk tolerance (accepting intermediate-risk 6.4%) provided 2.1% more donors (4.9% average transmission risk) and was dominant in 87% of simulations (mean +18.6 QALYs and AU$2.2m cost-savings).
Conclusions: Despite the additional risk of cancer transmission, accepting intermediate-risk donors with brain cancer is likely to increase the number of donor kidneys available for transplant, improve patient outcomes, and reduce overall healthcare expenditure.
Biography:
James is a PhD candidate at the University of Sydney. His thesis is on strategies to increase organ donation with a focus on increasing acceptance of donors with a history of cancer. He has a background in biostatistics and health economics, and previously worked as a consultant in the pharmaceutical industry.