Potential Unintended Consequences of National Infectious Disease Screening Strategies in Deceased Donor Kidney Transplan
- PDF / 1,340,689 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 42 Downloads / 190 Views
ORIGINAL RESEARCH ARTICLE
Potential Unintended Consequences of National Infectious Disease Screening Strategies in Deceased Donor Kidney Transplantation: A Cost‑Effectiveness Analysis Trevor A. Ellison1 · Samantha Clark2 · Jonathan C. Hong3 · Kevin D. Frick3,4 · Dorry L. Segev5,6
© Springer Nature Switzerland AG 2020
Abstract Background In order to counter the lack of sufficient kidney donors, there has been interest in expanding the utilization of organs from increased infectious-risk donors. Negative nucleic acid testing of increased infectious-risk organs has been shown to increase their use as compared to only enzyme-linked immunosorbent assay negativity. However, it is not known how the expanded use of nucleic acid testing on a national scale might affect total donor utilization. Objective The objective of this paper was to determine if a national screening policy requiring the use of nucleic acid testing in both increased infectious-risk and non-increased infectious-risk renal transplant donors would increase the donor organ pool. Methods This study used decision-tree analysis to determine the cost-effectiveness of four US national screening policies based on an increasingly expansive use of nucleic acid testing for increased infectious-risk and non-increased infectiousrisk kidneys. Parameters were taken from the literature. All costs were reported in 2020 US dollars using a Medicare payer perspective and a life-time horizon. Results The use of nucleic acid screening solely for increased infectious-risk organs was the dominant strategy. Our results were robust to deterministic and probabilistic sensitivity analyses. One of the main driving factors of cost-effectiveness was the false-positive rate of nucleic acid testing. Conclusion Before implementing nucleic acid screening outside of increased infectious-risk organs, its false-positivity rate should be directly studied to ensure that its use does not detrimentally affect transplantation numbers, quality-adjusted lifeyears, and costs. Key Points for Decision Makers
* Trevor A. Ellison [email protected] 1
Department of Cardiothoracic Surgery, Mount Carmel Health System, Columbus, OH, USA
Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
2
3
Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
4
Johns Hopkins Carey Business School, Baltimore, MD, USA
5
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
6
Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
Nucleic acid testing is used to shorten the window period for detecting HCV and HIV in organ donors as opposed to the standard enzyme-linked immunosorbent assay. Shortening the window period for detecting HCV and HIV in organ donors may lead to an increased use of infectious-risk donors. Due to the false-positive rate of nucleic acid testing, universal use of nucleic acid testing m
Data Loading...
