You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Modeling the Benefits and Costs of Integrating an Acceptable HLA Mismatch Allocation Model for Highly Sensitized Patients

Nguyen, Hung Do1,2,10; Wong, Germaine3,4; Howard, Kirsten3; Claas, Frans H.J.5; Craig, Jonathan C.3,4; Fidler, Samantha6,7; D’Orsogna, Lloyd6,7; Chapman, Jeremey R.4; Irish, Ashley1,9; Ferrari, Paolo1,9; Christiansen, Frank T.6,7; Lim, Wai H.1,2

Transplantation:
doi: 10.1097/01.TP.0000438639.36838.ac
Clinical and Translational Research
Abstract

Background: The Eurotransplant acceptable mismatch program has improved transplantation access for highly sensitized recipients. However, the benefits and costs of implementing such a program remain unknown.

Methods: Using decision analytical modeling, we compared the average waiting time for transplantation, overall survival gains (in life-years and quality-adjusted life-years gained), and costs of integrating an acceptable mismatch allocation model compared with the current deceased-donor kidney allocation model in Australia.

Results: Acceptable mismatches were identified in 12 of 28 (43%) highly sensitized recipients using HLAMatchmaker. Inclusion of acceptable mismatches in the current allocation model improved the transplantation access for four (14%) highly sensitized recipients, with an average reduction in waiting time of 34 months (from 86 to 52 months). Compared with the current allocation model, incorporating an acceptable mismatch allocation model achieved an overall lifetime gain of 0.034 quality-adjusted life-years and savings of over $4,000 per highly sensitized patient, with a small consequential loss of 0.005 quality-adjusted life-years and extra costs of $800 for every reallocated patient.

Conclusions: Despite modest overall health gains, application of an acceptable mismatch allocation model is an equitable approach to improve transplantation access for highly sensitized transplant candidates without compromising the overall health benefits among the other patients on the deceased-donor waitlist in Australia.

Author Information

1 School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia.

2 Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.

3 Sydney School of Public Health, The University of Sydney, Sydney, Australia.

4 Centre for Kidney Research, The Children’s Hospital at Westmead & Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.

5 Eurotransplant Reference Laboratory, Department Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden, The Netherlands.

6 School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Australia.

7 Department of Clinical Immunology, Royal Perth Hospital, Perth, Australia.

8 Department of Renal Medicine, Royal Perth Hospital, Perth, Australia.

9 Department of Renal Medicine, Fremantle Hospital, Fremantle, Australia.

10 Address correspondence to: Hung Do Nguyen, M.D., School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6009, Australia.

The authors declare no funding or conflicts of interest.

E-mail: hdnguyen@iinet.net.au

H.D.N. participated in designing and performing the research, analyzing the data, and writing the article. H.D.N. was supported by the Jacquot Research Entry Scholarship (administered by the Royal Australian College of Physicians) and the National Health and Medical Research Council Postgraduate Medical Scholarship for stipend. G.W. participated in designing and supervising the research, analyzing the data, and writing the article. K.H. participated in designing the research, analyzing the data, and writing the article. F.H.J.C. participated in writing the article. J.C.C. participated in designing the research and writing the article. S.F. participated in collecting patient clinical data. L.D. participated in writing the article. J.R.C. participated in designing the research and writing the article. A.I. participated in collecting patient clinical data. P.F. participated in writing the article. F.T.C. participated in designing the research and writing the article. W.H.L. participated in designing and supervising the research, and writing the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 5 August 2013. Revision requested 26 August 2013.

Accepted 10 October 2013.

Accepted December 27, 2013

© 2014 by Lippincott Williams & Wilkins