The Economic Burden of Posttransplant Events in Renal Transplant Recipients in Europe

Chamberlain, George1,4; Baboolal, Keshwar2; Bennett, Hayley1; Pockett, Rhys D.1; McEwan, Phil1; Sabater, Javier3; Sennfält, Karin3

doi: 10.1097/01.TP.0000438205.04348.69
Clinical and Translational Research

Background: This study aims to describe the healthcare resource utilization and costs of managing renal posttransplant patients over 3 years posttransplant in nine European countries and to stratify them by year 1 glomerular filtration rate (GFR).

Methods: A retrospective observational and database analysis of renal transplant patients and a physician questionnaire study were conducted to collect recipient and donor characteristics, posttransplant events, and healthcare resource utilization related to these posttransplant events. In each country, local published costs were applied to the resource use identified. The results were stratified by the patient GFR reading at a time point 1 year after renal transplant.

Results: The database study identified 3,181 patients who met the inclusion criteria, along with 2,818 transplants carried out in the centers surveyed by questionnaire. Total 3-year costs derived from the questionnaire analysis vary depending on local treatment practices, from a minimum of €33,602 per patient in the Czech Republic to €77,461 per patient in the Netherlands. Consistently across countries, estimated costs appear to decrease with improved graft functioning status (increased GFR) at 1 year. The average 3-year costs, discounting immunosuppresion therapy and certain posttransplant events, per patient with a GFR greater than or equal to 60 at 1 year are estimated to be around 35% lower than those with 15≤GFR<30.

Conclusion: This study demonstrates that in Europe, worsening posttransplant renal function may contribute to substantive increases in resource use, with some variation across regions. Therefore, management strategies that promote renal function after transplantation have the potential to provide important resource savings.

Supplemental digital content is available in the article.

1 Swansea Centre for Health Economics, Swansea University, Swansea, UK.

2 Division of Nephrology, University Hospital of Wales, Cardiff, UK.

3 Health Economics and Outcomes Research Europe, Bristol Myers Squibb Ltd., Paris, France.

4 Address correspondence to: George Chamberlain, Swansea Centre for Health Economics, Westgate House, Womanby Street, Cardiff, CF10 1BR, UK.

This study was funded by Bristol Myers Squibb for which K.S. and J.S. are employees. R.D.P., K.B., H.B., G.C., and PM acted as consultants to Bristol Myers Squibb.


G.C. participated in analyzing the data and writing the article. K.B. participatedin designing the research and writing the article. H.B. participated inanalyzing the data and writing the article. R.D.P. participated in writing the article. J.S. participated in coordinating the research and writing the article. P.M. participated in designing the research. K.S. participated in designing the research.

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 (

Received 11 June 2013. Revision requested 1 July 2013.

Accepted 22 Oct 2013.

Accepted January 24, 2014

© 2014 by Lippincott Williams & Wilkins