Economic evaluation of alternative kidney allocation schemes for the Access to Transplantation and Transplant Outcome Measures (ATTOM) study

Renal replacement therapies for patients with established renal failure, encompassing dialysis and transplantation, were among the first medical interventions to be assessed using methods of formal cost-effectiveness analysis. Previous economic evaluations have demonstrated that for most patients who are candidates for surgery, kidney transplantation results in improved survival and better quality of life at lower cost in comparison to chronic dialysis. However, transplant activity is limited by a shortage of donor organs. Therefore, there is interest in assessing whether the approach to allocating the limited number of donor kidneys can be further optimised to achieve maximal health benefit, while at the same time considering both equity and cost.

The aim of this research is to develop a model to facilitate comparison of both costs and health outcomes (in terms of quality-adjusted life years or QALYs) of alternative deceased donor kidney allocation schemes for patients with established renal failure in the UK. The model will be developed as a discrete event simulation using the software package SIMUL8 (Boston, MA). The analysis will aim to take into account relevant donor and recipient factors by drawing on sources of patient level data, including historical survival and cost information as well as data that is being collected as part of the ongoing national prospective observational cohort study entitled Access to Transplantation and Transplant Outcome Measures (ATTOM). The outputs of the model can be used to gain an understanding of the potential impact of changes to the national kidney allocation scheme and to inform future policy.

This research is embedded in an NIHR funded programme grant entitled Access to Transplantation and Transplant Outcome Measures (ATTOM), supported by the Department of Health, Renal Association, British Transplantation Society, UK Renal RegistryScottish Renal Registry and NHS Blood and Transplant.

The LSHTM-based research team includes John Cairns (Professor of Health Economics) and Bernadette Li (PhD Candidate). For further information, please contact Bernadette Li.

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