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Cost-Effectiveness Modeling of Simultaneous Pancreas-Kidney Transplantation

Published online by Cambridge University Press:  10 March 2009

Thomas V. Holohan
Affiliation:
U.S. Public Health Service

Abstract

A cost-effectiveness model was developed to compare simultaneous pancreas-kidney transplantation (SPK) to kidney transplantation alone (KTA) with continued insulin therapy among type-1 diabetics with end-stage renal disease. It appeared that the two procedures were equally cost-effective only for diabetics whose annual costs for treatment of complications of hyper-and were quite high.

Type
General Essays
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

1.American Diabetes Association. Direct and indirect costs of diabetes in the United State in 1992. Alexandria, VA: American Diabetes Association, 1993.Google Scholar
2.American Diabetes Association Technical Review and Position Statement, Committee on Professional Practice. Diabetes, 1992, 15, 1668–72.Google Scholar
3.Bandello, F., Vigano, C., & Secchi, A.Effect of pancreas transplantation on diabetic retinopathy: A 20-case report. Diabetologica, 1991, 34 (suppl. 1), S9294.CrossRefGoogle ScholarPubMed
4.Bandello, F., Vigano, C., Secchi, A., et al. The influence of combined kidney-pancreas transplantation on advanced diabetic retinopathy. Transplantation Proceedings, 1992, 24, 854.Google ScholarPubMed
5.Bentdal, O. H., Fauchald, P., Brekke, I. B., et al. Rehabilitation and quality of life in diabetic patients after successful pancreas-kidney transplantation. Diabetologica, 1991, 34 (suppl. 1), S158–59.Google Scholar
6.Bentley, F. R., & Garrison, R. N.Superior results with combined kidney-pancreas transplants. American Surgeon, 1992, 58, 136–40.Google Scholar
7.Bilous, R. W., Mauer, S. M., Sutherland, D. E., et al. The effects of pancreas transplantation on the glomerular structure of renal allografts in patients with insulin-dependent diabetes. New England Journal of Medicine, 1989, 321, 8085.Google Scholar
8.Bohman, S. O., Tyden, G., Wilczek, G., et al. Prevention of kidney graft diabetic nephropathy by pancreas transplantation in man. Diabetes, 1985, 34, 306–08.Google Scholar
9.Boucek, P., Bartos, V., Vanek, I., et al. Diabetic autonomic neuropathy after pancreas and kidney transplant. Diabetologica, 1991, 34 (suppl. 1), S121–24.Google Scholar
10.Brattstrom, C., Tibell, A., Tyden, G., et al. Outcome in 22 patients with pancreas transplants functioning beyond five years. Transplantation Proceedings, 1994, 26, 414–15.Google Scholar
11.Comi, G., Galardi, G., Amadio, S., et al. Neurophysiological study of the effect of combined kidney and pancreas transplantation on diabetic neuropathy: A two-year follow-up evaluation. Diabetologica, 1991, 34 (suppl. 1), S103–07.CrossRefGoogle Scholar
12.Egger, P. Office of Research & Demonstrations, Health Care Financing Administration, personal communication, 10 1, 1993.Google Scholar
13.Elkhammas, E. A., Henry, M. L., Tesi, R. J., et al. Combined kidney-pancreas transplantation at the Ohio State University hospitals. In Teresaki, P. & Cecka, E. (eds.), Clinical transplants. 1992, 191–97.Google Scholar
14.Evans, R. W.Cost-effectiveness analysis of transplantation. Surgical Clinics of North America, 1986, 66, 603–16.Google Scholar
15.Evans, R. W.Organ procurement expenditures and the role of financial incentives. Journal of the American Medical Association, 1993, 269, 3113–18.Google Scholar
16.Evans, R. W., Manninen, D. L., & Dong, F. B.The National Cooperative Transplantation Study: Final report, vol. 3. Vol. Ill, Ch. 12. Seattle, WA: Battelle-Seattle Research Center 1991, chapter 12, publication no. BHARC-1000–1091–020.Google Scholar
17.Fioretta, P., Mauer, S. M., Bilous, R. W., et al. Effects of pancreas transplantation on glomerular structure in insulin-dependent diabetic patients with their own kidneys. Lancet, 1993, 342, 1193–96.CrossRefGoogle Scholar
18.Garvin, P. J., Carney, K. M., & Aridge, D.Evolution of synchronous renal and pancreatic transplantation. American Journal of Surgery, 1989, 158, 625–29.Google Scholar
19.Griffin, P. J., Owens, D., Krishnan, H., et al. Pancreatic transplantation in a small program. British Journal of Surgery, 1994, 81, 98101.Google Scholar
20.Gross, C. R., & Zehrer, C. L.Health-related quality of life outcomes of pancreas transplant recipients. In Teresaki, P. & Cecka, E. (eds.), Clinical Transplantation, 1992, 6, 165–71.Google Scholar
21.Gross, C. R., & Zehrer, C. L.Impact of the addition of a pancreas to quality of life in uremic diabetic recipients of kidney transplants. Transplantation Proceedings, 1993, 25, 1293–95.Google Scholar
22.Hathaway, D. K., Hartwig, M. S., Milstead, J., et al. Improvement in quality of life reported by diabetic recipients of kidney-only and pancreas-kidney allografts. Transplantation Proceedings, 1994, 26, 512–14.Google Scholar
23.Health Insurance Association of America, personal communication, 10 26, 1993.Google Scholar
24.Holohan, T. V. Simultaneous pancreas-kidney and sequential pancreas-after-kidney transplantation. Health Technology Assessment Report. Rockville, MD: Agency for Health Care Policy and Research, Office of Health Technology Assessment, 1994.Google Scholar
25.Johnson, J. L., Schellberg, J., Munn, S. R., et al. Does pancreas transplantation really improve the patient's quality of life? Transplantation Proceedings, 1990, 22, 575–76.Google Scholar
26.Kennedy, W. R., Navarro, X., Goetz, F. C., et al. Effects of pancreatic transplantation on diabetic neuropathy. New England Journal of Medicine, 1990, 322, 1031–37.Google Scholar
27.Kiebert, G. M., Van Oosterhout, E. C., Lemkes, H., et al. Quality of life after combined renal-pancreatic transplantation. Transplantation Proceedings, 1994, 26, 517.Google Scholar
28.Konigsgrainer, A., Miller, K., Kieselbach, D., et al. Course of diabetic retinopathy after pancreas transplantation. Transplantation Proceedings, 1990, 22, 689-90.Google Scholar
29.Milde, F. K., Hart, L., & Zehr, P.Quality of life of pancreatic transplant recipients. Diabetes Care, 1992, 15, 1459–63.CrossRefGoogle ScholarPubMed
30.Morel, P., Sutherland, D. E., Almond, S., et al. Assessment of renal function in type I diabetic patients after kidney, pancreas, or combined kidney-pancreas transplantation. Transplantation, 1991, 51, 1184–89.CrossRefGoogle ScholarPubMed
31.Murat, A., Pouliquen, B., Cantarovich, D., et al. Gastric emptying improvement after simultaneous segmental pancreas and kidney transplantation. Transplantation Proceedings, 1992, 24, 855.Google Scholar
32.Nakache, R., Tyden, G., & Groth, C.Quality of life in diabetic patients after combined pancreas-kidney or kidney transplantation. Diabetes, 1989, 38 (suppl. 1), S40–42.Google Scholar
33.Nakache, R., Tyden, G., & Groth, C. G.Long-term quality of life in diabetic patients after combined pancreas-kidney transplantation or kidney transplantation. Transplantation Proceedings, 1994, 26, 510–11.Google Scholar
34.Naouri, A., Martin, X., & Dubernard, J. M.Evolution of diabetic neuropathy after kidney-pancreas transplant. Transplantation Proceedings, 24, 875–76.Google Scholar
35.Nusser, J., Scheuer, R., Abendroth, D., et al. Effect of pancreatic and/or renal transplantation on diabetic autonomic neuropathy. Diabetologica, 1991, 34 (suppl. 1), S118-20.Google Scholar
36.Petersen, M. R., & Vine, A. K.Progression of diabetic retinopathy after pancreas transplantation. Ophthalmology, 1990, 97, 496502.Google Scholar
37.Piehlmeier, W., Bullinger, M., Kirchberger, I., et al. Prospective study of the quality of life in type 1 diabetic patients before and after organ transplantation. Transplantation Proceedings, 1994, 26, 522–23.Google Scholar
38.Piehlmeier, W., Bullinger, M., Nusser, J., et al. Quality of life in diabetic patients prior to or after pancreas transplantation in relation to organ function. Transplantation Proceedings, 1992, 24, 871–73.Google Scholar
39.Piehlmeier, W., Bullinger, M., Nusser, J., et al. Quality of life in type I diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function. Diabetologica, 1991, 34 (suppl. 1), S150–57.Google Scholar
40.Ramsey, R. C., Goetz, F. C., Sutherland, D. E., et al. Progression of diabetic retinopathy after pancreas transplantation for insulin-dependent diabetes mellitus. New England Journal of Medicine, 1988, 318, 208–14.Google Scholar
41.Rosen, C. B., Frohnert, P. P., & Velosa, J. A., et al. Morbidity of pancreas transplantation during cadaveric renal transplantation. Transplantation, 1991, 51, 123–27.CrossRefGoogle ScholarPubMed
42.Rosenloff, L. K., Earnhardt, R. C., & Pruett, T. L.Pancreas transplantation: An initial experience with systemic and portal drainage of pancreatic allografts. Annals of Surgery, 1992, 215, 586-95.Google Scholar
43.Scheider, A., Meyer-Schwickerath, E., Nusser, J., et al. Diabetic retinopathy and pancreas transplantation: A three-year follow-up. Diabetologica, 1991, 34 (suppl. 1), S95–99.CrossRefGoogle Scholar
44.Scheider, A., Thurau, S., Ulbig, M., et al. Diabetic retinopathy remains stable after combined kidney and pancreas transplantation for type I (insulin-dependent) diabetes mellitus (abstract). Diabetologica, 1989, 32, 538A.Google Scholar
45.Secchi, A., Di Carlo, V., Martenenghi, S., et al. Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic type I diabetic patients. Diabetologica, 1991, 34 (suppl. 1), S141–44.CrossRefGoogle Scholar
46.Shaffer, D., Madras, P. N., Sayhoun, A. I., et al. Combined kidney and pancreas transplantation: A three-year experience. Archives of Surgery, 1992, 127, 574–78.Google Scholar
47.Solders, G., Tyden, G., Persson, A., et al. Improvement of nerve conduction in diabetic neuropathy: A follow-up study four years after combined pancreatic and renal transplantation. Diabetes, 1992, 41, 946–51.CrossRefGoogle Scholar
48.Sollinger, H. W., Knechtle, S. J., Reed, A., et al. Experience with 100 consecutive simultaneous kidney-pancreas transplants with bladder drainage. Annals of Surgery, 1991, 214, 703–11.CrossRefGoogle ScholarPubMed
49.Sollinger, H. W., Ploeg, R. J., Eckhoff, D. E., et al. Two hundred consecutive simultaneous pancreas-kidney transplants with bladder drainage. Surgery, 1993, 114, 736–44.Google Scholar
50.Stratta, R. J., Taylor, R. J.Ozaki, C. F., et al. A comparative analysis of results and morbidity in type I diabetics undergoing pre-emptive versus postdialysis combined pancreas-kidney transplantation. Transplantation, 1993, 55, 1097–103.Google Scholar
51.Stratta, R. J., Taylor, R. J., Ozaki, C. F., et al. The analysis of benefit and risk of combined pancreatic and renal transplantation versus renal transplantation alone. Surgery, Gynecology, and Obstetrics, 1993, 177, 163–71.Google Scholar
52.Stratta, R. J., Taylor, R. J., & Wahl, T. O.Recipient selection and evaluation for vascularized pancreas transplantation. Transplantation, 1993, 55, 1090–96.Google Scholar
53.Stratta, R. J., Taylor, R. J., Zorn, B. H., et al. Combined pancreas-kidney transplantation in Nebraska. Nebraska Medical Journal, 1991, 76, 385–91.Google Scholar
54.Sutherland, D. E., Dunn, D. L., & Goetz, F. C.A 10-year experience with 290 pancreas transplants at a single institution. Annals of Surgery, 1989, 210, 274–88.CrossRefGoogle ScholarPubMed
55.Sutherland, D. E., Greussner, R., Gillingham, K., et al. A single institution's experience with solitary pancreas transplantation: A multivariate analysis of factors leading to improved outcome. In Teresaki, P. & Cecks, E. (eds.), Clinical Transplants, 1991, 141–52.Google Scholar
56.Sutherland, D. E., Gruessner, A., Moudry-Munns, K., et al. Analysis of the United States Network for Organ Sharing (UNOS) USA Pancreas Transplant Registry. In, 1994 Annual Report of the U.S. Scientific Registry of Transplant Recipients and the Organ Procurement and Transplantation Network. Washington, DC: U.S. Department of Health and Human Services, 1994.Google Scholar
57.Torrance, G. W.Utility approach to measuring health-related quality of life. Journal of Chronic Diseases, 1987, 40, 593600.CrossRefGoogle ScholarPubMed
58.Torrance, G. W., & Feeny, D.Utilities and quality-adjusted life years. International Journal of Technology Assessment in Health Care, 1989, 5, 559–75.Google Scholar
59.Ulbig, M., Kampik, A., Thurau, S., et al. Long-term follow-up of diabetic retinopathy for up to 71 months after combined renal and pancreatic transplantation. Graefe's Archives of Clinical and Experimental Ophthalmology, 1991, 229, 242–45.CrossRefGoogle ScholarPubMed
60.Van Oosterhout, E. C., Vander Woude, F. J., Lemkes, H. H., et al. Simultaneous pancreas and kidney transplantation: A feasible procedure in selected patients. Netherlands Journal of Medicine, 1992, 41, 194–07.Google ScholarPubMed
61.Wilczek, H. E., Jaremko, G., & Groth, C. G.Pancreatic graft protects a simultaneously transplanted kidney from developing diabetic nephropathy: A 1- to 6-year follow-up study. Transplantation Proceedings, 1993, 25, 1314–15.Google Scholar
62.Zech, J. C., Trepsat, D., Gain-Gueugnon, M., et al. Ophthalmological follow-up of type I (insulin-dependent) diabetic patients after kidney and pancreas transplantation. Diabetologica, 1991, 34 (suppl. 1), S8991.Google Scholar
63.Zech, J. C., Trepsat, C., Gain-Guegnon, M., et al. Ophthalmologic follow-up of type I diabetic patients after kidney and pancreas transplantation. Transplantation Proceedings, 1992, 24, 874.Google Scholar
64.Zehrer, C. L., & Gross, C. R.Comparison of quality of life between pancreas/kidney and kidney transplant recipients: 1 year follow-up. Transplantation Proceedings, 1994, 26, 508–09.Google Scholar
65.Zehrer, C. L., & Gross, C. R.Quality of life of pancreas transplant recipients. Diabetologica, 1991, 34 (suppl. 1), S145–49.CrossRefGoogle ScholarPubMed