Potential Unintended Consequences of National Infectious Disease Screening Strategies in Deceased Donor Kidney Transplantation: A Cost-Effectiveness Analysis

Trevor A. Ellison (), Samantha Clark, Jonathan C. Hong, Kevin D. Frick and Dorry L. Segev
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Trevor A. Ellison: Mount Carmel Health System
Samantha Clark: University of Washington
Jonathan C. Hong: Johns Hopkins School of Public Health
Kevin D. Frick: Johns Hopkins School of Public Health
Dorry L. Segev: Johns Hopkins University School of Medicine

Applied Health Economics and Health Policy, 2021, vol. 19, issue 3, No 9, 403-414

Abstract: 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 infectious-risk 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 life-years, and costs.

Date: 2021
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DOI: 10.1007/s40258-020-00593-6

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