Cost-effectiveness analysis of dialysis and kidney transplants in Japan.

Although kidney transplantation is considered to be more desirable than dialysis in terms of cost-effectiveness and patients' quality of life, there have been very few cases of kidney transplants in Japan. This study was conducted to compare the cost-effectiveness of dialysis and kidney transplants using Disability-Adjusted Life Years (DALYs) as an indicator of effectiveness. Most data necessary for the DALYs analysis were obtained from publications. The disability weights for dialysis patients and kidney transplant patients were estimated based on a questionnaire e-mailed to medical officials of the Japanese Government. Expected duration of treatment was estimated from the survival rates of dialysis patients and the graft-survival rates of transplant patients using the Weibull model method. The cost of dialysis and living-related donor (LRD) transplant included only medical expenditures and neglected all other costs, and the cost of cadaveric donor (CAD) transplant included the budget for organ procurement and distribution in addition to medical expenditures. The analysis showed that dialysis averted 138,019 DALYs/year, living-related donor transplant averted 5,740 DALYs/year, and CAD transplant averted 1,892 DALYs/year. The cost-effectiveness ratio (C-E ratio) was 9,546 thousand yen/DALY for dialysis, 1,809 thousand yen/DALY for LRD transplant, and 2,322 thousand yen/DALY for CAD transplant. These results could be used for the decision making of the Government on what resources should be allocated to the promotion of kidney transplantation. Also, the methodology used in this study can be applied to cost-effectiveness analysis of other organ transplants.