Cost-Effectiveness Study Supports Sequential Living-Donor Evaluation

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When more than one potential living kidney donor comes forward, it is more cost-effective to evaluate them all at once, rather than one at a time, reports a study in Kidney International.

The researchers created a simple decision tree to assess the economic impact of simultaneous versus sequential evaluation of multiple potential living kidney donors. In many transplant programs, donors are evaluated one at a time, to avoid the costs of performing unnecessary evaluations.

The costs of evaluation were indeed higher when two candidates were evaluated simultaneously: $1266 (Canadian dollars) higher than sequential evaluation. However, simultaneous evaluation was also associated with a shorter time to kidney transplantation: 1 month shorter than with sequential evaluation.

The reduction in time to transplantation avoided $6931 in dialysis costs; total savings were $5665 per intended recipient. Other benefits included a 1% increase in living-donor kidney transplants and improved quality of life for recipients, due to less time on dialysis.

For potential recipients who had not yet started dialysis, simultaneous evaluation was also associated with a 2% reduction in the rate of dialysis initiation. Simultaneous evaluation of three or four potential donors had similar benefits.

Evaluating multiple potential living kidney donors simultaneously is the “dominant strategy” in terms of cost-effectiveness, compared to sequential evaluation. Savings accrue from having the recipient spend less time on dialysis, or from starting dialysis in the first place. The investigators conclude: “Evaluating up to four living donor candidates simultaneously rather than sequentially is one cost-effective solution to reduce the overall costs of healthcare and improve outcomes in this population” [Habbous S, et al. Evaluating multiple living kidney donor candidates simultaneously is more cost-effective than sequentially. Kidney Int 2020; DOI: https://doi.org/10.1016/j.kint.2020.06.015].

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