The cost-effectiveness of using payment to increase living donor kidneys for transplantation

Abstract

Background and objectives: For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors.

Design, setting, participants, & measurements: Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data.

Results: Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively.

Conclusion: Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.

Figure 1.

Overview of model. QALY, quality-adjusted life year.

Figure 2.

Two-way sensitivity analysis: cost per QALY gained for varying payments to living donor ($10,000–$50,000) and varying increases in transplantation.

Figure 3.

Tornado diagram representing the incremental cost-effectiveness ratios of one-way sensitivity analyses under base case conditions.

Figure 4.

Incremental cost-effectiveness scatter plot of a strategy of paying living donors compared with the current organ donation system.