A federal analysis puts the central benefits associated with a 2019 U.S. kidney initiative at $103 billion to $206 billion through 2040, while cautioning that it does not prove the policy caused transplant growth.
The U.S. Department of Health and Human Services (HHS), through its Office of the Assistant Secretary for Planning and Evaluation, published the analysis Oct. 20. Under conservative assumptions, it estimates 1,055 additional transplants each year; the optimistic scenario estimates 2,110. Across 2019-2040, those figures amount to 23,214 and 46,428 additional transplants, respectively.
The $103 billion and $206 billion figures are central estimates for the conservative and optimistic scenarios. A sensitivity analysis that changes the assigned value of a statistical life-year produces a broader range, from $57 billion to $295 billion.
HHS assigns value to reduced mortality risk, improved quality of life and time patients might save by avoiding dialysis. The scenarios also project 147,410 to 294,819 life-years gained and 21,821 to 43,643 quality-adjusted life-years. The analysis applies a 3% discount rate.
The department excluded changes in medical spending from its total benefits estimate because those estimates vary. Depending on the assumptions, HHS cites estimates ranging from $36,667 in net lifetime savings to about $12,000 in additional spending per transplant.
To assess the initiative’s possible contribution, analysts compared transplant activity after 2019 with a modeled baseline for a path without the policy. The compound annual growth rate was 2.6% in 2009-2018 and 2.8% in 2019-2025. HHS says other developments may also have affected the later rate, including the 2014 Kidney Allocation System, changes in deceased-donor transplants and state policies.
President Donald Trump signed Executive Order 13879 on July 10, 2019. It directed HHS to propose a regulation revising organ procurement organization rules and evaluation metrics to establish transparent, reliable and enforceable performance measures. The order also called for faster kidney matching and delivery; HHS says the reforms sought to strengthen incentives to identify donors, recover organs and place them for transplant.
