Value for money in kidney transplant decision making: economic evaluations of contemporary practices

Speaker

Dr Sameera Jayan Senanayake, Queensland University of Technology

Sameera Senanayake is a health economist at the Australian Centre For Health Services Innovation (AusHSI), Queensland University of Technology. He began his career as a doctor in Sri Lanka before completing his Master’s and Doctor of Medicine (MD) degrees in public health from the University of Colombo, Sri Lanka and a PhD in health economics from the Queensland University of Technology. He completed his PhD in 2021, and during his PhD, he synthesized evidence that can assist decision-making concerning the most efficient use of donor kidneys. So far, during his short academic career, he has authored more than 50 peer-reviewed publications, has given nearly 60 conference presentations and attracted more than $1M in grant funding. His research interests include choice modelling using discrete choice experiments (DCE), decision-analytic modelling (Markov and discrete event simulations), and predictive modelling using statistical and machine learning methods.

Abstract

Compared to other available renal replacement therapies, renal transplantation improves the survival and quality of life of patients with end-stage renal disease. However, donor kidneys are a scarce resource, and health systems around the world have not been able to meet the growing demand for kidney grafts. Shifting to a “soft opt-out” organ donation system, transplanting low-quality kidneys and allocating donor kidneys to recipients based on the presumed longevity of the kidney graft are three strategies that are being tried to increase the kidney donor pool and meet the demand for donor kidneys. 

‘Soft opt-out’ is an alternative approach to ‘opt-in’ organ donation in Australia. This approach legislatively presumes that all potential donors are willing to donate unless explicitly registering their objection. High-quality cost-effective evidence regarding the likely impact of legislative changes related to the ‘soft opt-out’ approach to kidney donation remains scant. As low-quality kidney transplants are associated with higher rates of graft loss and primary renal allograft dysfunction, they cost more than a regular transplant. Therefore, due to the greater likelihood of short-term costs associated with low-quality kidney transplants, health systems around the world are reluctant to increase those transplants due to an assumption that they may threaten the overall economic viability of transplant programs. Furthermore, the changes to costs and health outcomes arising from ‘longevity matching’ on the Australian healthcare system are unknown. 

The presentation outlines the long-term cost-effectiveness of shifting to a “soft opt-out” organ donation system, transplanting low-quality kidneys and allocating donor kidneys to recipients based on the presumed longevity of the kidney graft. In the context of the widening gap between the supply and demand of donor kidneys, the evidence outlined in the presentation is expected to narrow the gap and ensure that this scarce resource is utilized efficiently.

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