The Economic Imperative of Living Donor Kidney Transplantation: A Single-Center Micro-Cost Analysis for Sustainable ESRD Care in Saudi Arabia.

BACKGROUND

Living donor kidney transplantation (LDKT) is the definitive treatment for end-stage renal disease (ESRD), yet locally generated economic data remain limited. This single-center study provides a primary micro-costing comparison of LDKT, hemodialysis (HD), and peritoneal dialysis (PD) from a hospital finance perspective in a central Saudi tertiary-care facility.

METHODS

A retrospective micro-costing analysis was conducted from the healthcare provider perspective, capturing all direct medical costs from 2020 to 2023 over a 1-year horizon. Detailed cost components for HD (156 sessions/year), PD, and LDKT (donor and recipient pathways) were extracted from institutional financial records. A deterministic one-way sensitivity analysis was conducted to assess robustness.

RESULTS

HD incurred the highest annual cost ($67,311.96), primarily due to personnel, consumables, and vascular access interventions. PD costs $58,946.50 annually, attributable principally to dialysate procurement. LDKT required an initial combined donor-recipient first-year investment of $60,693 (donor: $7942; recipient: $52,751), followed by a substantially lower annual maintenance cost of $12,150. Cumulative analysis demonstrated that LDKT achieves financial break-even with HD within the first 12 months and becomes the dominant long-term strategy, a result consistent across all sensitivity scenarios.

CONCLUSIONS

LDKT provides rapid and sustained economic advantages over dialysis modalities within the Saudi hospital context. HD entails the highest ongoing cost, whereas PD offers a more cost-effective dialysis option. The immediate break-even point and long-term cost savings of LDKT provide strong evidence to support the expansion of LDKT and PD programs as essential components of sustainable ESRD care in Saudi Arabia.