Last update:
16-Sep-2004

OBJECTIVE Kidney transplantation technology has reached a very high standard in the last decades. In the industrialised countries it belongs to the services which are offered by high-level hospitals besides university clinics. The number of transplantations is limited almost exclusively by the scarce graft supply. As health care budgets are increasingly limited, advanced and costly technologies have to prove their cost-effectiveness. This article presents a study about cost, quality of life and cost-effectiveness of kidney transplantation in a major hospital in Germany.

METHOD From the waiting list of Hannover Medical School (MHH) 1,149 patients with end-stage renal disease (ESRD) were enrolled in the study and asked to answer the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) questionnaires. Of the waiting list group, 199 patients underwent transplantation during the 16-month study period. The cost incurred by 77 patients was fully documented for their hospitalization period. A comparison of direct and indirect cost for dialysis and kidney transplantation and cost utility analysis (QALY approach) was conducted.

RESULTS The average direct cost of kidney transplantation was 59,980 DM (indirect cost: 5,150 DM) in the first year. The cost of immunosuppressive drugs and subsequent care was 15,006 DM per year. Kidney transplantation is cost saving two years after operation (in comparison to dialysis). In addition, quality of life scores were higher for the transplanted patients.

CONCLUSIONS Kidney transplantation has advantages both for patients with regard to quality of life and for health insurances with regard to lower cost of care for ESRD patients.

Key words: Cost utility, Dialysis, Germany, Kidney transplant, QALYs.