Economic Analysis of Screening for Subclinical Rejection in Kidney Transplantation using Protocol Biopsies and Non-Invasive Biomarkers.


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.

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