Subclinical rejection (SCR) screening in kidney transplantation (KT) using protocol biopsies and non-invasive biomarkers has not been evaluated from an economic perspective. We assessed cost-effectiveness from health sector perspective of SCR screening in the first year after KT using a Markov model that compared no screening with screening using protocol biopsy or biomarker at 3 months, 12 months, 3 and 12 months, or 3, 6 and 12 months. We used 12% subclinical cellular rejection and 3% subclinical antibody mediated rejection (SC-ABMR) for the base-case cohort. Results favored one-time screening at peak SCR incidence rather than repeated screening. Screening two or three times was favored only with age60years. Using biomarker twice or thrice was cost-effective only if biomarker cost was <$700. In conclusion, in kidney transplantation, screening for SCR more than once during the first year is not economically reasonable. Screening with protocol biopsy was favored over biomarkers.
Puttarajappa CM, Mehta R, Roberts MS, Smith KJ, Hariharan S. (2020). Economic Analysis of Screening for Subclinical Rejection in Kidney Transplantation using Protocol Biopsies and Non-Invasive Biomarkers. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons