The economic benefit of allocation of kidneys based on cross-reactive group matching

Background. Recently the United Network for Organ Sharing (UNOS) began a pi lot study to evaluate prospectively the merits of an allocation of cadaveri c kidneys based on broader classes of HLA antigens, called cross-reactive g roups (CREG), The objectives of the pilot study consider patient outcomes, but not the potential economic impact of a CREG-based allocation. This stud y predicts the impact of a CREG-based local allocation of cadaveric kidneys on 3-year Medicare payments and graft survival. Methods. The UNOS renal transplant registry was merged to Medicare claims d ata for 1991-1997 by the United States Renal Data System. Average accumulat ed Medicare payments and graft survival up to 3 years posttransplant for fi rst cadaveric renal transplant recipients were stratified by cross reactive group mismatch categories. The economic impact was defined as the differen ce in average 3-year costs per transplant between the current and proposed allocation algorithms. Average 3-year costs were computed as a weighted ave rage of costs, where the weights were the actual and predicted distribution s of transplants across cross-reactive group categories. Results. Results suggest that an organ allocation based on cross reactive g roup matching criteria would result in a 3-year cost savings of $1,231 (2%) per transplant, and an average 3-year graft survival improvement of 0.6%. Conclusions. Cost savings and graft survival improvements can be expected i f CREG criteria were to replace current criteria in the current allocation policy for cadaveric kidneys, although the savings appear to be smaller tha n may be achievable through expanded HLA matching.