ESTIMATING THE ECONOMIC BURDEN OF PRE-TRANSPLANT HEMODIALYSIS FOR KIDNEY TRANSPLANT RECIPIENTS IN BRAZIL: INSIGHTS FROM REAL-WORLD DATA
Author(s)
Jéssica Nacazume, B.Sc1, Lucas Lima Torres, BSc, MSc2, Juliana Garrido, MD, M.Sc1.
1Novartis Biociências S.A., São Paulo, Brazil, 2Novartis Biociências S.A., Belo Horizonte, Brazil.
1Novartis Biociências S.A., São Paulo, Brazil, 2Novartis Biociências S.A., Belo Horizonte, Brazil.
OBJECTIVES: Advanced stages of chronic kidney disease pose clinical and economic challenges, eventually leading to kidney failure. Patients often spend years on dialysis before transplantation, and nearly 40% lack a defined underlying cause, revealing missed opportunities for targeted management. This study aimed to estimate the burden of hemodialysis preceding kidney transplantation within Brazil’s Unified Health System (SUS) over 24 years.
METHODS: Annual kidney transplant numbers were obtained from the Brazilian Transplant Registry (2000-2024). Pre-transplant hemodialysis volume was estimated assuming three weekly sessions and a median of 38 months on dialysis before transplantation, based on a 16-year SUS retrospective cohort. To reflect the SUS perspective, patients with private insurance were excluded using historical data. Costs were derived from SUS reimbursement values and converted to international dollars (Int$) using year-specific purchasing power parity (PPP). Analyses assumed population comparability across secondary data sources to estimate annual and cumulative hemodialysis volume and costs.
RESULTS: Each kidney transplant recipient was estimated to complete 495 hemodialysis sessions prior to transplantation. Between 2000 and 2024, 117,055 transplants performed corresponded to 57.9 million hemodialysis sessions, of which 44.9 million were attributed to SUS-exclusive patients, with a cumulative cost of Int$ 4.4 billion (BRL 7.5 billion). Over 24 years, annual transplants, hemodialysis sessions, and costs nearly doubled. In 2000, 2,912 transplants represented 1.18 million hemodialysis sessions. By 2024, 6,297 transplants corresponded to 2.36 million sessions, costing Int$ 228.8 million (BRL 567.7 million).
CONCLUSIONS: This analysis highlights the impact of dialysis preceding transplantation in SUS, with millions of sessions and billions in spending. As only direct hemodialysis costs were considered, the true system and societal burden is likely underestimated. These findings support prioritization of strategies that delay progression to kidney failure, by improving etiological diagnosis and enabling earlier, targeted interventions to postpone dialysis initiation and reduce long-term pressure on the healthcare system.
METHODS: Annual kidney transplant numbers were obtained from the Brazilian Transplant Registry (2000-2024). Pre-transplant hemodialysis volume was estimated assuming three weekly sessions and a median of 38 months on dialysis before transplantation, based on a 16-year SUS retrospective cohort. To reflect the SUS perspective, patients with private insurance were excluded using historical data. Costs were derived from SUS reimbursement values and converted to international dollars (Int$) using year-specific purchasing power parity (PPP). Analyses assumed population comparability across secondary data sources to estimate annual and cumulative hemodialysis volume and costs.
RESULTS: Each kidney transplant recipient was estimated to complete 495 hemodialysis sessions prior to transplantation. Between 2000 and 2024, 117,055 transplants performed corresponded to 57.9 million hemodialysis sessions, of which 44.9 million were attributed to SUS-exclusive patients, with a cumulative cost of Int$ 4.4 billion (BRL 7.5 billion). Over 24 years, annual transplants, hemodialysis sessions, and costs nearly doubled. In 2000, 2,912 transplants represented 1.18 million hemodialysis sessions. By 2024, 6,297 transplants corresponded to 2.36 million sessions, costing Int$ 228.8 million (BRL 567.7 million).
CONCLUSIONS: This analysis highlights the impact of dialysis preceding transplantation in SUS, with millions of sessions and billions in spending. As only direct hemodialysis costs were considered, the true system and societal burden is likely underestimated. These findings support prioritization of strategies that delay progression to kidney failure, by improving etiological diagnosis and enabling earlier, targeted interventions to postpone dialysis initiation and reduce long-term pressure on the healthcare system.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE435
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Urinary/Kidney Disorders