SP793Costs of long-term post-transplant care in renal transplant recipients

Abstract

INTRODUCTION: Solid organs transplantations lead to improvement in both patients' survival, and quality of life [1,2]. In cases when alternative therapies are available, for example in patients with endstage renal disease (ESRD), who may be treated with dialyses instead of transplantation, transplantations are also connected to economical benefits [3]. However, with time after renal transplantation, health problems connected with aging as well as complications of immunosuppression accumulate, including cardio‐vascular diseases, neoplastic diseases, infections, etc [4‐6]. They are connected with substantial costs. Therefore, we supposed that in the late post‐transplant period, costs of care increase. To verify this hypothesis, costs of posttransplant care in renal transplant recipients who were in different periods after transplantation were calculated. METHODS: In 2018, 2571 renal transplant recipients were treated in the outpatient department of the Department of Immunology, Transplant Medicine, and Internal Diseases of the Medical University of Warsaw. From between this population, study group was randomly selected. Study group consisted of renal transplant recipients in different post‐transplant periods (1‐25 years after transplantation). Subsequently, costs of 1‐year care defrayed in 2017 by our transplant center in individual post‐transplant years were retrospectively calculated, based on case records. Direct costs of hospitalizations as well as outpatient care, including laboratory diagnostics, imaging, and treatment, were taken into account. Costs of the first hospitalization at the surgical ward, connected to transplant procedure, were omitted. Similarly, we did not include in our analysis costs of immunosuppression used outside the hospital, as in our healthcare system they are not covered by the transplant center. Additionally, costs of diagnostics and treatment provided by general practitioners and other specialist centers were also not included into our analysis. Mainly due to the fact that, in our center, the care of renal transplant recipients starts in different moments after the transplant procedure, calculated costs were divided by the number of months when the patients were actually remaining under the care of our center. That is why results of our calculations are expressed as the mean costs of 1‐month care in the particular posttransplant year. Additionally, medians of these costs are presented, as the distribution of data was not always normal, and then, the means do not reflect the real situation.Calculated costs are presented in the local currency (1PLN∼0.23EUR). RESULTS: 306 renal transplant recipients were included into the study, including 174 men, and 132 women. Mean age was 55 years. All of them were Caucasians. Renal transplantations were performed 1‐25 years before inclusion to the study. Table 1 summarizes demographic data of participants.The mean cost of 1‐month posttransplant care was the highest in the first posttransplant year (1974.69 PLN). Afterwards, mean costs of 1‐month post‐transplant caredecreased; between 2nd and 9th post‐transplant year, they were between 213.87 and 1111.22 PLN. Then, in years 10‐25, they were below 559 PLN per 1 month. CONCLUSIONS: Our results confirm that renal transplantation is a modality of RRT that is associated with economic benefits even in such long period.