Budget Impact Analysis of Increasing Kidney Transplantation in Québec

End-stage renal disease (ESRD) is characterized by the irreversible loss of kidney function. This is the most advanced stage of chronic kidney disease. Although the incidence rate of ESRD appears to be stabilizing, the prevalence of treated people is steadily rising. In order to ensure the survival of patients with chronic renal failure, kidney function must be replaced by exogenous blood filtration mechanisms, such as dialysis, or by kidney transplantation.

However, these different treatments require the continual use of specialized human and material resources associated with financial considerations that are placing an increasingly heavy burden on Québec’s health system budget. The use of kidney transplantation helps ease this pressure because the annual follow-up care for transplant patients is much less costly than hemodialysis and other forms of dialysis. In addition, kidney grafts greatly enhance patient survival and quality of life.

Prior to considering any increase in the number of kidney grafts, it is essential to compare the relative costs of the different ESRD treatments and their use in the face of a growing prevalence in order to fully assess the real impact on the budget that the government allocates to renal replacement.

With that in mind, the Direction de la biovigilance (now merged with the Direction de l’accès des technologies et de la biologie médicale) within the Ministère de la Santé et des Services sociaux du Québec asked for a budget impact analysis comparing Québec’s costs associated both with the care required by people undergoing hemodialysis while waiting for a kidney transplant and with transplantation, including organ removal and post-transplantation care. This analysis, based on the treatment modalities observed in the population concerned, will make it possible to evaluate the cost savings generated by increasing the number of kidney transplants, which will also help shorten the lists of people waiting for transplants and improve their quality of life.