Is simultaneous pancreas kidney transplant the most cost-effective strategy for type 1 diabetes patients with renal failure?

• Published in: Proceedings of Singapore healthcare Vol. 25; no. 2; pp. 127 - 134
• Main Authors: Ong, Siew Chin, Lee, Victor Tswen-Wen, Lim, Jeremy Fung Yen, Chow, Wai Leng, Tong, Shao Chuen, Kee, Terence Yi-Shern, Madhavan, Krishnakumar
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2016; Sage Publications Ltd; SAGE Publishing
• Subjects: Cost analysis; Diabetes; Hemodialysis; Kidney transplants; renal failure; type 1 diabetes; cost-utility analysis; simultaneous pancreas kidney transplant; Cost-effectiveness
• ISSN: 2010-1058; 2059-2329
• DOI: 10.1177/2010105815610137

Introduction: Simultaneous pancreas kidney transplant (SPK) has shown beneficial outcomes in type 1 diabetes patients with renal failure (IDDM-RF). The objective of this study was to assess its cost-effectiveness compared with other treatment strategies for IDDM-RF. Methods: A decision analytic model was developed for IDDM-RF treatment with four possible strategies: deceased donor kidney transplant (DDKT), living donor kidney transplant (LDKT), SPK and dialysis. A cost-utility analysis from the healthcare provider perspective was conducted based on a five-year model. Local data were used whenever possible except for SPK survival variables, wherein data from United Network for Organ Sharing and Scientific Registry of Transplant Recipients were used. Sensitivity analyses were performed to evaluate the impact of uncertainties around key variables. Results: In the baseline analysis, LDKT was the most cost-effective strategy with the lowest cost per quality-adjusted life year gained, i.e. SGD77,068, followed by SPK (SGD82,991), DDKT (SGD92,432) and dialysis (SGD181,192). The DDKT was extended dominated by dialysis and LDKT strategies. Incremental cost-effectiveness ratios with dialysis as a reference for LDKT and SPK strategies were SGD43,094 and SGD56,201, respectively. Both strategies are considered highly cost-effective under World Health Organization (WHO) guidelines. In the sensitivity analysis, a 6% increase in both SPK kidney graft survival and patient survival would make SPK the most cost-effective strategy. Conclusions: Both LDKT and SPK are highly cost-effective strategies in the treatment of IDDM-RF. SPK is potentially the most cost-effective strategy if a 6% increase in both SPK kidney graft survival and patient survival is achieved.