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Effects of Kidney Transplantation on Labor Market Outcomes in Sweden

Jarl, Johan, PhD1; Gerdtham, Ulf-G., PhD1,2; Desatnik, Peter, MD3; Prütz, Karl-Göran, MD4,5

doi: 10.1097/TP.0000000000002228
Original Clinical Science—General
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Background Kidney transplantation is considered a superior treatment for end-stage renal disease compared with dialysis although little is known about the wider effects, especially on labor market outcomes. The objective is to estimate the treatment effect of kidney transplantation compared with dialysis on labor market outcomes, controlling for the nonrandom selection into treatment.

Methods The average treatment effect is estimated using an inverse-probability weighting regression adjustment approach on all patients in renal replacement therapy 1995 to 2012.

Results Kidney transplantation is associated with a treatment advantage over dialysis on employment, labor force participation, early retirement, and labor income. The probability of being employed 1 year after treatment is 21 (95% confidence interval, 16-25) percentage points higher for transplantation. The positive effect increases to 38 (95% confidence interval, 30-46) percentage points after 5 years, mainly due to worsening outcomes on dialysis. The effect on labor income is mainly mediated through employment probability. The productivity gains of transplantation compared to dialysis amounts to €33 000 over 5 years.

Conclusions Transplantation is superior to dialysis in terms of potential to return to work as well as in terms of labor income and risk of early retirement, after controlling for treatment selection. This positive effect increases over time after transplantation.

Based on Swedish registries' data between 1995 and 2012, the authors compare the labour market outcomes between patients treated by dialysis or kidney transplantation controlling for treatment selection bias. These outcomes are far better when patients receive a kidney graft and this superiority still grows with time.

1 Health Economics, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.

2 Department of Economics, Lund University, Lund, Sweden.

3 Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.

4 Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.

5 Swedish Renal Registry, Ryhov Hospital, Jönköping, Sweden.

Received 28 September 2017. Revision received 16 March 2018.

Accepted 21 March 2018.

Financial support from Region Skåne, Sweden (regional public healthcare provider), and the Government Grant for Clinical Research (“ALF”) is greatly acknowledged.

The authors declare no conflicts of interest. The results presented in this article have not been published previously in whole or part.

All authors participated in the design of the study, interpretation of the results, and write-up. J.J. conducted the analyses and drafted the first version. All authors have approved the final version.

Correspondence: Johan Jarl, PhD, Box 117 221 00 Lund, Sweden. (johan.jarl@med.lu.se).

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).

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