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  1. Cost-utility analysis of living-donor kidney transplantation followed by pancreas transplantation versus simultaneous pancreas-kidney transplantation.

    Article - En anglais

    For a type I diabetic with end-stage renal disease, the choice between a kidney-alone transplant from a living-donor (KA-LD) and a simultaneous pancreas-kidney (SPK) transplant remains a difficult one.

    The prevailing practice seems to favor KA-LD over SPK, presumably due to the superior long-term renal graft survival in KA-LD and the elimination of the lengthy waiting time on the cadaver transplant list.

    In this study, two treatment options, KA-LD followed by pancreas-after-kidney (PAK) and SPK transplant, are compared using a cost utility decision analysis model.

    The decision tree consisted of a choice between KA-LD+PAK and SPK.

    The analysis was based on a 5-yr model and the measures of outcome used in the model were cost, utility and cost-utility.

    The expected 5-yr cost was $277 638 for KA-LD+PAK and $288 466 for SPK.

    When adjusted for utilities, KA-LD+PAK at a cost of $153 911 was less cost-effective than SPK at a cost of $110828 per quality-adjusted year.

    One-way sensitivity analyses were performed by varying patient and graft survival probabilities, utilities and cost.

    SPK remained the optimal strategy over KA-LD+PAK across all variations.

    Two-way sensitivity analysis showed that in order for KA - LD+PAK to be at least as cost-effective as SPK, 5-yr pancreas and patient survival rates following PAK would need to surpass 86 and 80%. (...)

    Mots-clés Pascal : Homotransplantation, Rein, Pancréas, Analyse coût, Economie santé, Traitement, Simultané, Pronostic, Homme, Transplantation, Chirurgie

    Mots-clés Pascal anglais : Homotransplantation, Kidney, Pancreas, Cost analysis, Health economy, Treatment, Concurrent, Prognosis, Human, Transplantation, Surgery

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 99-0168775

    Code Inist : 002B25H. Création : 16/11/1999.