The cost of a kidney transplant has dropped so significantly that University of Maryland School of Medicine researchers say it is cheaper to have a transplant than to stay on dialysis for more than two and a half years, even among the sickest patients.
"We found that the break even point was 2.7 years for all of the cases we analyzed. And, for 30 percent of our patients who did not need to be re-admitted to the hospital during the year after their transplant, the break even point was only 1.7 years," says Eugene J. Schweitzer, M.D., a transplant surgeon at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine.
Dr. Schweitzer will present findings at the American Society of Transplant Surgeons meeting in Chicago on May 20 which show that a kidney transplant is much more cost effective than dialysis even for the highest risk patients-those with heart disease, diabetes or older age. That analysis was done on 227 patients who received kidneys from living donors from March 1996 to December 1998.
A separate, detailed analysis by University of Maryland researchers of 184 transplant patients came up with the break even point of 2.7 years compared to dialysis. That study was published in the journal, Transplantation, in December 1998.
"Our studies show that not only does a kidney transplant improve the quality of life for patients, it also saves money in the long run," says Stephen T. Bartlett, M.D., head of the division of Transplant Surgery at the University of Maryland Medical Center and professor of surgery and medicine at the University of Maryland School of Medicine.
The analysis found that after 2.7 years, the medical system saves about $27,000 per year for each patient who has a transplant instead of remaining on kidney dialysis. By comparison, in 1989, studies elsewhere had shown the break even point to be 3.6 years. About 220,000 people are on kidney dialysis in the U.S.
The major cost saving comes from shortening the length of hospital stay from an average of 10 to 7 days after the transplant, and eliminating the use of expensive anti-rejection drugs that were given intravenously in the hospital following the operation. Better oral anti-rejection medications are now available which patients can take at home. In addition, the increased use of living donor kidneys can reduce costs, since those kidneys tend to function better right after the transplant than those from cadaver donors.
"The cost of kidney dialysis averages about $44,000 per year per patient, using 1993 figures. The average cost for the transplant patients in our study, including the transplant surgery and medical care for the first year following surgery was $89,939. After the first year, costs for the transplant patients averaged $16,043; mostly for medications to prevent rejection.
"We have a focused, comprehensive program for our transplant patients and their families that includes a lot of education and support both before and after the transplant, which has enabled us to get patients out of the hospital sooner," says Dr. Bartlett. "In fact, one-third of our patients are now able to go home within three days of their transplant, without an increased risk of re-admission," he adds.