Real-world economic comparison of preemptive kidney transplant vs maintenance dialysis in patients with end-stage kidney disease.

BACKGROUND

A direct comparison of healthcare resource utilization (HCRU) and associated costs in patients with end-stage kidney disease (ESKD) who received preemptive kidney transplants (PKT; defined as the receipt of a kidney transplant in a patient without a prior history of dialysis) vs maintenance dialysis (MD) in US clinical practice is lacking.

METHODS

This retrospective, observational study evaluated data from Optum's deidentified Clinformatics Data Mart Database (January 2012-July 2024) on patients with ESKD who received PKT or MD. HCRU and costs (standardized to 2024 US dollars) at 24-month follow-up were compared by weighted generalized linear modeling.

RESULTS

In total, 14,135 ESKD patients (1153 who received PKT and 12,982 undergoing MD) were analyzed. Patients in the PKT cohort were more likely to be hospitalized vs the MD cohort (odds ratio [OR] = 10.68; 95% CI = 6.00-19.02), with more hospitalizations per person (event rate ratio [ERR] = 1.21; 95% CI = 1.05-1.39). Patients receiving PKT were less likely to visit the emergency department vs those undergoing MD (OR = 0.49; 95% CI = 0.33-0.72), with fewer emergency department visits per person (ERR = 0.31; 95% CI = 0.24-0.42). Almost all patients had ≥1 outpatient visit; however, the number of outpatient visits per person was lower in the PKT cohort vs the MD cohort (ERR= 0.30, 95% Cl = 0.27-0.33). PKT costs initially exceeded MD, but MD costs surpassed PKT from approximately month 5 onward. Estimated total all-cause per person costs were $303,725 (for PKT) and $637,134 (for MD), representing a saving of $333,409 (95% CI = $263,461-$403,356) at 24 months for PKT.

CONCLUSIONS

Despite substantially higher initial costs, patients receiving PKT had lower HCRU and costs at 24 months, demonstrating that PKT was less costly compared with MD during the study follow-up.