Introduction
Methods
Search strategy
Data extraction
Assessment of the quality of the economic evaluation
Assessment of the quality of the data used in each evaluation
Results
Assessment of the reporting quality of the economic evaluations
CHEERS criterion | CUA of transplanting infectious kidneys (n = 03) | CUA of kidney allocation policies (n = 09) | CUA of technology used in KT (n = 04) | Total (%) (n = 16) | |
---|---|---|---|---|---|
1 | Title | 1 | 4 | 3 | 8 (50.0) |
2 | Abstract | 1 | 5 | 3 | 9 (56.3) |
3 | Background and objectives | 3 | 9 | 4 | 16 (100.0) |
4 | Target population and subgroups | 3 | 9 | 4 | 16 (100.0) |
5 | Setting and location | 2 | 9 | 3 | 14 (87.5) |
6 | Study perspective | 2 | 8 | 4 | 14 (87.5) |
7 | Comparators | 3 | 9 | 4 | 16 (100.0) |
8 | Time horizon | 3 | 7 | 4 | 14 (87.5) |
9 | Discount rate | 3 | 9 | 4 | 16 (100.0) |
10 | Choice of health outcomes | 3 | 9 | 2 | 14 (87.5) |
11 | Measurement of effectiveness | 2 | 9 | 4 | 15 (93.8) |
12 | Measurement and valuation of preference-based outcomes | NA | 1a | NA | 01 (100.0) |
13 | Estimating resources and costs | 1 | 9 | 4 | 14 (87.5) |
14 | Currency, price date, and conversion | 2 | 8 | 4 | 14 (87.5) |
15 | Choice of model | 2 | 7 | 3 | 12 (75.0) |
16 | Assumptions | 3 | 5 | 2 | 10 (62.5) |
17 | Analytical methods | 0 | 5 | 0 | 05 (31.3) |
18 | Study parameters | 2 | 6 | 4 | 12 (75.0) |
19 | Incremental costs and outcomes | 3 | 8 | 3 | 14 (87.5) |
20 | Characterising uncertainty | 3 | 8 | 4 | 15 (93.8) |
21 | Characterising heterogeneity | 0 | 2 | 0 | 02 (12.5) |
22 | Study findings, limitations, generalisability, and current knowledge | 2 | 7 | 4 | 13 (81.3) |
23 | Source of funding | 1 | 7 | 2 | 10 (62.5) |
24 | Conflicts of interest | 1 | 5 | 2 | 08 (50.0) |
Assessment of the quality of the data used in evaluations
Evidence ranking | CUA of transplanting infectious kidneys (n = 03) | CUA of kidney allocation policies (n = 09) | CUA of technology used in KT (n = 04) | ||||||
---|---|---|---|---|---|---|---|---|---|
Clinical data | Cost data | Utility data | Clinical data | Cost data | Utility data | Clinical data | Cost data | Utility data | |
High quality | |||||||||
Rank 1 | 1 | 1 | – | 8 | 8 | 1 | – | 2 | – |
Rank 2 | 1 | 2 | 2 | 1 | 1 | 8 | 4 | 2 | 4 |
Medium quality | |||||||||
Rank 3 | – | – | – | – | – | – | – | – | – |
Low quality | |||||||||
Rank 4 | 1 | – | 1 | – | – | – | – | – | – |
Rank 5 | – | – | – | – | – | – | – | – | – |
Evidence of CUA
Study | Country | Year | Perspective | Discount rate (%) | Time horizon | Model structure |
---|---|---|---|---|---|---|
CUA of transplanting infectious kidneys (n = 03) | ||||||
Kadatz et al. [26] | Canada | 2018 | Health- care payer and Societal | 1.5 | 10 years | Markov decision model |
Kiberd et al. [27] | Canada | 1994 | Not explicitly stated (Health- care payer costs identified) | 5 | 20 years | Not explicitly stated (Markov decision model identified) |
Schweitzer et al. [34] | USA | 2007 | Societal perspective | 3 | 20 years | Markov decision model |
CUA of kidney allocation policies (n = 09) | ||||||
Axelrod et al. [21] | USA | 2018 | Health- care payer | 3 | 10 years | Discreet Event Simulation |
Smith et al. [35] | USA | 2015 | Health- care payer | 3 | 20 years | Markov decision model |
Mutinga et al. [31] | USA | 2005 | Not explicitly stated (Health- care payer costs identified) | 5 | 20 years | Markov decision model |
Schnitzler et al. [33] | USA | 2003 | Health- care payer | 5 | 20 years | Markov decision model |
Bavanandan et al. [23] | Malaysia | 2015 | Health- care payer | 3 | Life time | Not explicitly stated (Markov decision model identified) |
Snyder et al. [36] | USA | 2010 | Societal perspective | 3 | 10 years | Markov decision model |
Cavallo et al. [24] | Italy | 2014 | Health- care payer | 3.5 | 05 years | Markov decision model |
Barnieh et al. [22] | Canada | 2013 | Health- care payer | 5 | Life time | Markov decision model |
Matas et al. [29] | USA | 2003 | Societal perspective | 5 | 20 years | Markov decision model |
CUA of technology used in KT (n = 04) | ||||||
Nguyen et al. [32] | Australia | 2015 | Health- care payer | 5 | 20 years | Markov decision model |
McLaughlin et al. [30] | Canada | 2006 | Health- care payer | 5 | 25 years | Markov decision model |
Groen et al. [25] | Europe | 2012 | Health- care payer | 4 | 10 years | Markov decision model |
Liem et al. [28] | Netherlands | 2003 | Societal perspective | 3 | Life time | Markov decision model |
Study | Study population | Intervention | Comparator | Incremental cost effectiveness ratio (ICER) | Willingness to pay threshold | Sensitivity analysis-method | Sensitivity analysis-results |
---|---|---|---|---|---|---|---|
CUA of transplanting infectious kidneys (n = 03) | |||||||
Kadatz et al. [26] | Patients waitlisted for KT | Transplanting a HCV- NAT positive deceased donor kidney followed by post-transplant direct acting anti-viral administration | Remaining on the waitlist for a kidney transplant from an HCV NAT- negative donor | ICER is US$ 56,018 if receiving a HCV NAT positive kidney shortens the wait-time by 1 year. Remaining on the waitlist for 2 or more years is dominatedb compared to receiving a HCV NAT positive kidney | US $ 50,000 | PSA, SA | Robust |
Kiberd et al. [27] | Patients waitlisted for KT | Allocation polices based on donor and recipient HCV status | Comparison between each option | Option (b) over option (c)—ICER US$ 18,760/QALY. Option (a) over option (b)—Dominatedb Option (c) over option (a)—Dominanta | Not mentioned | SA | Variable |
discard all HCV+ donors | |||||||
screen all donors and transplant infected organs into HCV+ recipients only | |||||||
ignore HCV status and transplant without screening | |||||||
Schweitzer et al. [34] | Patients waitlisted for KT | Transplant kidneys from both standard donors and CDC-IRDs | Only transplant kidneys from standard donors. Discard kidneys from CDC-IRDs | Dominanta | Not mentioned | OW, SA | Robust |
CUA of kidney allocation policies (n = 09) | |||||||
Axelrod et al. [21] | Patients waitlisted for KT | KDPI ≤85 DKT | Patients continuing on HD | US $ 83/QALY | US $ 100,000 | Not done | – |
KDPI >85 DKT | US $ 32,870/QALY | ||||||
PHS increased risk DKT | US $ 7944/QALY | ||||||
HLA 0‐3 mismatch LKT | Dominanta | ||||||
HLA 4‐6 mismatch LKT | Dominanta | ||||||
ABOi LKT | US $ 34,755/QALY | ||||||
ILKT | US $ 102,859/QALY | ||||||
Smith et al. [35] | Patients waitlisted for KT | A policy of transplanting the top 20% of the KDPI to candidates in the top 20% of expected survival | Conventional allocation policy | Dominanta | Not mentioned | OW | Robust |
Mutinga et al. [31] | Patients waitlisted for KT | HLA-B locus not matched before kidney allocation | HLA-B locus matched before kidney allocation | US $ 7300 cost saving per lost QALY | Not mentioned | PSA, SA | Robust |
Schnitzler et al. [33] | Patients waitlisted for KT | Accepting a ECD kidney | Accepting a standard kidney | ICER value not mentioned. SD US $ 56,058/QALY ECD US $ 72,838/QALY | Not mentioned | OW | Robust |
Bavanandan et al. [23] | Patients waitlisted for KT | Kidney transplantation using live donors | Kidney transplantation using deceased donors | Dominanta | Not mentioned | OW | Robust |
Snyder et al. [36] | Patients waitlisted for KT | A waitlist with both DBD and DCD kidneys | A waitlist only with DBD | Dominanta | Not mentioned | OW, TW, PSA | Robust |
Cavallo et al. [24] | Patients waitlisted for KT | Assumption of 10 extra DCD transplants per year after implementing the programme Alba [40] | Baseline practice | US $ 7025/QALY | Not mentioned | OW | Variable |
Assumption of 10% extra transplants from each donation type (DCD, DBD, live) per year after implementing the programme Alba [40] | Baseline practice | Dominanta | OW | Variable | |||
Barnieh et al. [22] | Patients waitlisted for KT | A payment of US $8000 (2010) to all the living donors, which would expect the annual transplant rate to increase by 5%. | Current KT practice | Dominanta | Not mentioned | OW, TW, PSA | Variable |
Matas et al. [29] | Patients waitlisted for KT | Patients receiving a paid living unrelated donor kidney | Patients continuing on HD | It would be cost-effective to add one vendor to the donor pool if the payment made to that vendor for donation was no more than US $351,065 | Not mentioned | OW | Variable |
CUA of technology used in KT (n = 04) | |||||||
Nguyen et al. [32] | KT recipients (DKT and LKT) | Using bead-based multiplex assays (threshold MFI level 500) with CDC | Only CDC | Dominanta | Not mentioned | OW, PSA | Robust |
McLaughlin et al. [30] | Patients undergoing DKT | Flow screening only, where patients’ immunological risks were stratified using the results of FCXM and flow micro-bead PRA | Serological screening only, where patients’ immunological risks were stratified using the result of AHG enhanced CDCXM and PRA titer only | Dominanta | Not mentioned | OW | Robust |
Groen et al. [25] | Patients undergoing KT | Hypothermic machine preservation as the organ preservation method in KT | Use of Static cold storage | Dominanta | Not mentioned | Bootstrapping | Robust |
Liem et al. [28] | Live kidney donors undergoing pre-operative imaging | Different combinations of strategies; MRIA, SCTA, DSA with MRA, MRIA and DSA if MRIA inconclusive, MRIA with SCTA | Pre-operative imaging DSA | DSA dominated all the imaging strategies | Not mentioned | OW, TW | Variable |