Cost -effectiveness analysis of simultaneous pancreas -kidney transplantation

Simultaneous pancreas-kidney transplant (SPK) is increasingly viewed as a treatment of choice for persons with type I diabetes and renal failure. However, the benefits of SPK vs. kidney transplant alone (KTA) with continued insulin therapy have not been thoroughly evaluated, particularly by using the most comprehensive available data sources or most powerful analytic techniques for estimating survival.;The primary objective of this study is to examine the incremental cost-effectiveness of SPK as compared to KTA, using a Markov model. Main outcomes include life expectancy, quality-adjusted life years (QALYs), and lifetime costs. Patient and graft survival rates came from the Medicare ESRD Program for kidney transplant and United Network for Organ Sharing for pancreas transplant (1988 to 1998). Cox proportions hazard models were used to estimate the transition probabilities. The Medicare payment databases (1991 to 1998) were used for enumeration of cost estimates. The annual cost estimates were adjusted for case-mix differences using generalized linear models based on gamma distribution with log-link function. Utility estimates were the predicted Quality of Well-Being scores from a longitudinal QOL study and values from published literature. The utilities from the QOL study were adjusted for selection bias using selectivity-corrected models.;The major findings are as follows. Estimated life expectancy is 13.4 years for an SPK recipient and 10.6 years for a KTA recipient. When the life expectancy is adjusted by quality of life, SPK generates 9.2 QALYs and KTA generates 6.4 QALYs. Lifetime costs of treatment are ;The results from this study provide explicit information based on the health care sector perspective about the incremental benefits and costs of choosing one transplant procedure over another for type I diabetic ESRD patients. SPK rather than KTA should be offered to this population.