In 45-year old patients with no comorbidities, listing for transplantation cost AUD 504,908 and the expected life years were 9.57; with no listing plus dialysis, the costs were AUD 476,639 and the life years were 7.16. The incremental cost per life year gained with listing for transplantation over no listing plus dialysis was AUD 11,730. The incremental cost-effectiveness ratio (ICER) ranged from AUD 8,965 (for diabetes) to AUD 14,829 (for obesity) depending on patient comorbidity.
In 60-year old patients with no comorbidities, listing for transplantation cost AUD 509,423 and the expected life years were 7.78; with no listing plus dialysis, the costs were AUD 495,394 and the expected life years were 6.39. The incremental cost per life year gained with listing over no listing was AUD 35,902. The ICER ranged from AUD 17,668 (for obesity) to AUD 40,915 (for patients who smoked) depending on patient comorbidity.
Listing for transplantation was dominant (gained 3.84 life years and saved AUD 16,272) over no listing plus dialysis in a 25-year old patient with no comorbidities.
All ICERs were below the cost-effectiveness threshold of AUD 50,000 per life year gained for all comorbidities.
The scenario analysis showed that age at the time of listing and waiting time on the deceased donor transplant list were the two most influential inputs.
The probabilistic analysis suggested that (for example) listing a 45-year old patient with diabetes achieved on average a gain of 1.5±0.5 additional life years compared with no listing plus dialysis. The gain in life years was 0.62 in an older patient with diabetes, but varied between 0.45 and 0.80 compared with no listing plus diabetes.