COST-EFFECTIVENESS OF REPEAT MEDICAL PROCEDURES - KIDNEY-TRANSPLANTATION AS AN EXAMPLE

The constraints on medical-care resources can give rise to the questio n of the cost-effectiveness of permitting repeat medical procedures wh en some patients may die without undergoing even a first procedure. Us ing kidney transplantation as an example, this study estimates the cos t-effectiveness of patients' having available the option of a repeat m edical procedure in the event the first procedure fails. Specifically, the analysis examines the effect on transplant candidates of having t he option of kidney retransplantation, if and when retransplantation m ight be needed. Data sources include the U.S. Renal Data System (USRDS ) Case-Mix Severity Study, Health Care Financing Administration (HCFA) data, and a MEDLINE search. Outcome measures include life expectancy, quality-adjusted life expectancy, lifetime costs of medical care, and marginal cost-effectiveness from a societal perspective. By avoiding lifelong dialysis after graft failure, first-transplant candidates gai n an average of 47 quality-adjusted days with a retransplantation poli cy, despite the prolongation of time to first transplant by an average of 30 quality-adjusted days. The lifetime cost of medical care per fi rst-transplant candidate is $1,210 higher with a retransplantation pol icy compared with the no-retransplantation policy; its societal cost-e ffectiveness is estimated to be $9,656 per quality-adjusted life-year saved. The retransplantation policy provides the greatest improvement in quality-adjusted life expectancy for younger candidates. In the cas e of kidney transplantation, the cost-effectiveness of a repeat transp lant, on average, compares favorably with those of other medical strat egies in common practice. As resources become increasingly constrained , this study demonstrates a framework for considering the cost-effecti veness of repeat medical procedures.