Korean J Transplant.  2022 Nov;36(Supple 1):S203. 10.4285/ATW2022.F-3388.

Health technology assessment of kidney transplantation and hemodialysis for the treatment of end-stage kidney disease

  • 1Department of Internal Medicine, Faculty of Medical and Health Sciences, Udayana University, Denpasar, Indonesia
  • 2Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia


Kidney transplantation is an expensive procedure, and it is an alternative treatment of end-stage renal disease other than dialysis. Cost-effectiveness and the cost-utility study was undertaken at Prof. Dr. I.G.N.G Ngoerah Hospital, Bali, In-donesia aiming to assess whether living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease. A health technology assessment was done in living-related kidney transplant and hemodialysis during 2018.
Data search from internet resources using the electronic library and critically appraised the best evidence of the data of best data of 5-year mortality and survival of kidney transplant and hemodialysis. A preliminary study about quality of life (QOL) was also done among kidney transplant and hemodialysis patients.
Fourteen living-related kidney transplant patients consisted of 14 recipients, 12 males and two females aged 27–55 years and 14 donors, three males and 11 females aged 24–63 years were included. Thirty hemodialysis patients at the same hospital were also recruited consisted of 20 males and 10 females, with average age 50.9 years. Average 5-year cost of kidney transplant was 49895.51 USD, while cost of hemodialysis was 39152.34 USD, leading to cost difference was 10743.17 USD. Five-year mortality of kidney transplant was 55%, (survival 45%), 5 years survival rate was 18.9%. Five years of survival differ-ence between kidney transplant and hemodialysis was 26.1 %. Meanwhile, QOL for kidney transplant was 0.7063 and hemodial-ysis was 0.5596, leading to QOL difference 0.15. Kidney transplantation will spend 411.38 USD for every 1% increase of survival during 5 years with 15% better QOL. In 5 years, kidney transplantation produces 67% ICER, and from cost-utility perspective kidney transplantation yields 2089.87 USD per QALY or 2,217 USD per QALY.
Living-related kidney transplantation is more cost-effective and cost-utility than hemodialysis in the treatment of end-stage renal disease.

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