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
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0168775
Code Inist : 002B25H. Création : 16/11/1999.