Transplant Trial Watch

A Cost-Effectiveness Analysis of Organ Preservation Methods for Deceased Donor Kidneys at High Risk for Delayed Graft Function in Brazil.

Tedesco Silva, H., Jr., Evans, R. W. et al.

Transplant Proc, 2018;50(10):3121-7.


Aims
This analysis aims to consider the cost-effectiveness of machine perfusion, relative to static cold storage, based on clinical data from patients in the Brazilian multi-center clinical trial.

Interventions
Comparison of cost effectiveness between machine perfusion and static cold storage in the Brazilian cohort.

Participants
A decision tree model that simulates the 1000 kidney transplant recipients from data derived from the Brazilian multi-center clinical trial cohort.

Outcomes
The decision tree model aimed to measure three possible graft outcomes following 1 year post-transplantation: graft success, graft failure or delayed graft function. Alongside this, quality of life of machine perfusion relative to static cold storage was assessed.

Follow-up
1 Year

CET Conclusions
This was a cost-effectiveness analysis of a randomised controlled trial (RCT) that compared machine perfusion with static cold storage in 80 pairs of deceased donor kidneys. The RCT found that the incidence of delayed graft function (DGF) was significantly lower following machine perfusion compared to static cold storage (45% versus 61%). A decision tree model was developed based on the Brazilian National Health System and accounted for the possible outcomes DGF, an immediately functioning kidney and primary non-function requiring return to dialysis. Cost-effectiveness was reported as the incremental cost-effectiveness ratio (ICER). Quality of life was included in the model as health utility but as the outcome was not collected in the trial, assumptions for health utility values were based on the published literature. At 1-year post-transplant machine perfusion was cost-effective compared to static cold storage. The authors concluded that machine perfusion leads to more functioning kidneys and better quality of life compared to static cold storage.

Jadad score
3

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
None

Funding source
Industry funded