Real-world economic comparison of preemptive kidney transplant vs maintenance dialysis in patients with end-stage kidney disease

BACKGROUND: A direct comparison of healthcare resource utilization (HCRU) and associated costs in patients with end-stage kidney disease (ESKD) who received preemptive kidney transplants (PKT; defined as the receipt of a kidney transplant in a patient without a prior history of dialysis) vs maintenance dialysis (MD) in US clinical practice is lacking. METHODS: This retrospective, observational study evaluated data from Optum's deidentified Clinformatics Data Mart Database (January 2012-July 2024) on patients with ESKD who received PKT or MD. HCRU and costs (standardized to 2024 US dollars) at 24-month follow-up were compared by weighted generalized linear modeling. RESULTS: In total, 14,135 ESKD patients (1153 who received PKT and 12,982 undergoing MD) were analyzed. Patients in the PKT cohort were more likely to be hospitalized vs the MD cohort (odds ratio [OR] = 10.68; 95% CI = 6.00-19.02), with more hospitalizations per person (event rate ratio [ERR] = 1.21; 95% CI = 1.05-1.39). Patients receiving PKT were less likely to visit the emergency department vs those undergoing MD (OR = 0.49; 95% CI = 0.33-0.72), with fewer emergency department visits per person (ERR = 0.31; 95% CI = 0.24-0.42). Almost all patients had ≥1 outpatient visit; however, the number of outpatient visits per person was lower in the PKT cohort vs the MD cohort (ERR= 0.30, 95% Cl = 0.27-0.33). PKT costs initially exceeded MD, but MD costs surpassed PKT from approximately month 5 onward. Estimated total all-cause per person costs were $303,725 (for PKT) and $637,134 (for MD), representing a saving of $333,409 (95% CI = $263,461-$403,356) at 24 months for PKT. CONCLUSIONS: Despite substantially higher initial costs, patients receiving PKT had lower HCRU and costs at 24 months, demonstrating that PKT was less costly compared with MD during the study follow-up.