Service Use and Costs Associated with Kidney Transplant. Executive Summary.

摘要

The primary goal of the research was to examine changes in overall resources use and costs associated with kidney transplant, particularly as affected by the introduction of cyclosporine (CsA). Specific factors studied include donor status, medication regimen, and clinical characteristics of patients who received a renal transplant at UCSF between 1982 and 1986. The study cohort consisted of 703 patients, of which 464 received kidneys from cadaver donors and 239 received kidneys from living-related donors. Graft survival during the transplant hospitalization was significantly better in CsA treated patients, although the effect was limited almost entirely to cadaver donor patients. In the cadaver donor group, over four times as many no-CsA patients lost their graft compared to CsA patients (25.2% vs 6.1%). During the transplant hospitalization, the use of CsA for cadaver donor patients was associated with a significantly shorter adjusted mean length of stay (27.0 days vs 35.9 days) and lower adjusted mean hospital charges ($28,313 vs $37,210), although CsA was associated with little change in service use for living-related donor patients. Analyses of one-year follow-up data were conducted using only the 202 cadaver-patients. During the post-transplant period there were noo significant differences in number of hospitalization days or in total costs between the CsA and no-CsA groups. The results suggest that cyclosporine had a substantial cost-lowering effect during the transplant hospitalization, but that there was little additional benefit during the post-discharge period.