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Healthcare Costs for the Evaluation, Surgery, and Follow-Up Care of Living Kidney Donors

Habbous, Steven, MSc1; Sarma, Sisira, PhD1; Barnieh, Lianne J., PhD2; McArthur, Eric, MSc3; Klarenbach, Scott, MD, MSc4; Manns, Braden, MD, MSc5,6; Begen, Mehmet A., MSc, PhD1,7; Lentine, Krista L., MD, PhD8; Garg, Amit X., MD, PhD1,2,3 for the Donor Nephrectomy Outcomes Research (DONOR) Network

doi: 10.1097/TP.0000000000002222
Original Clinical Science—General

Background The healthcare costs to evaluate, perform surgery, and follow a living kidney donor for the year after donation are poorly described.

Methods We obtained information on the healthcare costs of 1099 living kidney donors between April 1, 2004, and March 31, 2014, from Ontario, Canada, using comprehensive healthcare administrative databases. We estimated the cost of 3 periods of the living donation process: the predonation evaluation period (start of evaluation until the day before donation), perioperative period (day of donation until 30-days postdonation), and 1 year of follow-up period (after perioperative period until 1 year postdonation). We analyzed data for donors and healthy matched nondonor controls using regression-based methods to estimate the incremental cost of living donation. Costs are presented from the perspective of the Canadian healthcare payer (2017 CAD $).

Results The incremental healthcare costs (compared with controls) for the evaluation, perioperative, and follow-up periods were CAD $3596 (95% confidence interval [CI], CAD $3350-$3842), CAD $11 694 (95% CI, CAD $11 415-CAD $11 973), and $1011 (95% CI, CAD $793-CAD $1230), respectively, totalling CAD $16 290 (95% CI, CAD $15 814-CAD $16 767). The evaluation cost was higher if the intended recipient started dialysis partway through the donor evaluation (CAD $886; 95% CI, CAD $19, CAD $1752). The perioperative cost varied across transplant centers (P < 0.0001).

Conclusions Although substantial costs of living donor care are related to the nephrectomy procedure, comprehensive assessment of costs must also include the evaluation and follow-up periods. These estimates are informative for planning future work to support and expand living donation and transplantation, and directing efforts to improve the cost efficiency of living donor care.

In this retrospective study regarding the total cost of kidney living donation in Ontario, the authors sum up the costs related to predonation, 30-days and 1-one year post donation to get realistic figures that will need to be taken into account in order to promote living donation.

1 Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.

2 Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.

3 Institute for Clinical Evaluative Sciences, Ontario, Canada.

4 Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.

5 Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

6 O’Brien Institute for Public Health and Libin Cardiovascular Institute, University of Calgary, Calgary Alberta, Canada.

7 Ivey School of Business, Western University, London, Ontario, Canada.

8 Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.

Received 18 December 2017. Revision received 8 February 2018.

Accepted 21 February 2018.

S.H. is supported by the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Doctoral Scholarship (funding reference GSD 140313). A.G. is supported by the Dr. Adam Linton Chair in Kidney Health Analytics, and a Canadian Institutes of Health Research Clinician Investigator Award.

A.X.G. received partnership funding from Astellas for a research grant funded by the Canadian Institutes of Health Research. The other authors declare no conflicts of interest.

The Institute for Clinical Evaluative Sciences (ICES) is a nonprofit research corporation funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The MOHLTC provided large administrative datasets to which the TGLN Network data were linked. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information. The study was conducted at the ICES Western facility, which receives financial support from the Academic Medical Organization of Southwestern Ontario, the Schulich School of Medicine and Dentistry at Western University, the Lawson Health Research Institute and multiple clinical Departments. The study was conducted through the ICES Kidney, Dialysis and Transplantation (KDT) Research Program, which receives programmatic support from the Canadian Institutes of Health Research.

The study design and conduct, opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding sources. No endorsement by ICES, CIHI, the MOHLTC or TGLN is intended or should be inferred. Amit Garg was supported by the Dr. Adam Linton Chair in Kidney Health Analytics and a Canadian Institutes of Health Research Clinician Investigator Salary Award. Graduate students who worked on this project were provided space in the Lilibeth Caberto Kidney Clinical Research Unit.

S.H., S.S., L.B., E.M., S.K, B.M., B.M., K.L.L., A.X.G. participated in research design. S.H., S.S., L.B., E.M., S.K., B.M., B.M., K.L.L., A.X.G. participated in the writing of the article. S.H., S.S., L.B., E.M., S.K., B.M., B.M., K.L.L., A.X.G. participated in the performance of the research. S.H., S.S., E.M., A.X.G. participated in the data analysis.

Correspondence: Steven Habbous, MSc, Institute for Clinical Evaluative Sciences Western Facility (ICES Western), Victoria Hospital, Room ELL-215, 800 Commissioners Rd, London, Ontario, Canada N6A 5W9. (

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