TABLE 1.
Clinical, costs, and utilities data for the model
| Clinical data | Estimates | References | |
|---|---|---|---|
| Utility | 33,34 | ||
| Transplant | 0.74 | ||
| Graft loss and return to dialysis | 0.62 | ||
| Acute rejection | 0.59 | ||
| Diagnosis of BKVAN | 0.64 | ||
| Dialysis survival | |||
| Patient survival on dialysis | Age, y | 35,36 | |
| First year | 18–24 | 0.98 (0.96–0.99) | |
| 25–44 | 0.96 (0.96–0.97) | ||
| 45–64 | 0.94 (0.93–0.94) | ||
| 65–74 | 0.89 (0.88–0.90) | ||
| 75–84 | 0.84 (0.83–0.85) | ||
| ≥85 | 0.76 (0.72–0.79) | ||
| 2 y | 18–24 | 0.96 (0.94–0.97) | 35,36 |
| 25–44 | 0.93 (0.92–0.93) | ||
| 45–64 | 0.87 (0.87–0.88) | ||
| 65–74 | 0.79 (0.78–0.80) | ||
| 75–84 | 0.71 (0.69–0.72) | ||
| ≥85 | 0.57 (0.53–0.62) | ||
| 5 y | 18–24 | 0.94 (0.92–0.95) | 35,36 |
| 25–44 | 0.85 (0.83–0.86) | ||
| 45–64 | 0.94 (0.69–0.70) | ||
| 65–74 | 0.89 (0.88–0.90) | ||
| 75–84 | 0.34 (0.33–0.36) | ||
| ≥85 | 0.18 (0.15–0.23) | ||
| Transplant survival | |||
| Patient survival: deceased donor transplant | 35,36 | ||
| First year | 0.97 (0.97–0.98) | ||
| 5 y | 0.90 (0.88–0.91) | ||
| 10 y | 0.75 (0.73–0.77) | ||
| 15 y | 0.64 (0.61–0.66) | ||
| Graft survival: deceased donor transplant | 35,36 | ||
| First year | 0.97 (0.97–0.98) | ||
| 5 y | 0.90 (0.88–0.91) | ||
| 10 y | 0.75 (0.73–0.77) | ||
| 15 y | 0.48 (0.46–0.51) | ||
| Patient survival: living donor transplant | 35,36 | ||
| First year | 0.99 (0.98–1.00) | ||
| 5 y | 0.96 (0.94–0.97) | ||
| 10 y | 0.88 (0.86–0.89) | ||
| 15 y | 0.76 (0.74–0.79) | ||
| Graft survival: living donor transplant | 35,36 | ||
| First year | 0.98 (0.97–0.99) | ||
| 5 y | 0.89 (0.88–0.91) | ||
| 10 y | 0.75 (0.73–0.77) | ||
| 15 y | 0.55 (0.52–0.58) | ||
| Graft rejection | |||
| Probability of graft rejection: first 6 mo | 35,36 | ||
| Living donor | |||
| First graft | 0.191 | ||
| Subsequent grafts | 0.216 | ||
| Deceased donor | |||
| First graft | 0.185 | ||
| Subsequent grafts | 0.20 | ||
| Probability of acute rejection: first 12 mo | 0.214 | 37 | |
| Probability of acute rejection: subsequent years | 0.04 | 38 | |
| Acute rejection and DSA | |||
| Probability of acute rejection with BK infection | 0.215 | 21 | |
| Probability of acute rejection with high viremia | 0.34 | 22 | |
| Probability of acute rejection with low viremia | 0.17 | 22 | |
| Probability of acute rejection but no DSA in patients with PyVAN | 0.06 | 23 | |
| Probability of acute rejection with DSA in patients with PyVAN | 0.19 | 24,25 | |
| Probability of no acute rejection but has DSA in patients with PyVAN | 0.1 | 21,39 | |
| Probability of no acute rejection and no DSA in patients with PyVAN | 0.65 | 21,39 | |
| Graft dysfunction (no-screen arm) | |||
| Probability of graft dysfunction from all causes | 0.4 | 39 | |
| Probability of PyVAN in patients with graft dysfunction | 0.11 | 40,41 | |
| Probability of acute rejection in patients with graft dysfunction | 0.22 | 25 | |
| Graft loss in patients with PyVAN | |||
| Probability of graft loss in patients with PyVAN and acute rejection | 0.057 | 4,20 | |
| Probability of graft loss in patients with PyVAN but no rejection | 0.048 | 4,20 | |
| Graft loss in patients without PyVAN | |||
| Probability of graft loss from all causes | 0.147 | 27 | |
| Probability of graft loss after acute rejection | 0.038 | 20 | |
| Probability of graft loss from acute rejection | 0.03 | 42 | |
| Probability of graft loss without PyVAN | 0.046 | 20,30 | |
| BK infection within the first year | |||
| Probability of positive BKPCR within the first year | 0.10–0.30 | 20 | |
| Probability of positive BK viral load >10 000 if PCR is +ve | 0.25 | 20 | |
| Probability of positive BK viral load <10 000 if PCR is +ve | 0.75 | 20 | |
| Probability of PyVAN with BK viral load >10 000 | 0.87 | 20 | |
| Probability of PyVAN with BK viral load <10 000 | 0.31 | 20 | |
| Late diagnosis of BK: no-screening arm | |||
| Probability of graft loss from BK without monitoring | 0.46 | 26 | |
| Probability of retransplantation | 0.05 | 35 | |
| Recurrence of BK in retransplantation | |||
| Probability of recurrence in the second/subsequent transplants | 0.175 | 43 | |
| Probability of BKVAN in the second transplant with recurrence | 0.06 | 44 | |
| Survival of retransplants after previous graft loss | |||
| Patient survival | 43 | ||
| Years after transplant | 1 | 0.985 (0.93–1.00) | |
| 2 | 0.985 (0.93–1.00) | ||
| 3 | 0.985 (0.93–1.00) | ||
| Graft survival | 44 | ||
| Years after transplant | 1 | 0.96 (0.88–1.00) | |
| 2 | 0.94 (0.85–1.00) | ||
| 3 | 0.94 (0.85–1.00) | ||
| Costs and resource uses, $ (AUD) | 45–50 | ||
| Access surgery | 1043 | 800–1500 | |
| Biopsy | 607 | 500–750 | |
| Death | 6000 | 2000–10 000 | |
| Home hemodialysis | 50 045 | 45 000–100 000 | |
| Center hemodialysis | 85 987 | 60 000–120 000 | |
| Peritoneal dialysis | 70 304 | 50 000–100 000 | |
| Transplant: first year | 51 044 | 40 000–100 000 | |
| Transplant: subsequent years | 18 864 | 10 000–50 000 | |
| Immunosuppression reduction | 4380 | 2000–5000 | |
| Polyomavirus PCR test: initial (per test) | 29 | 20–50 | |
| Polyomavirus PCR test: monitoring | 762 | 500–1000 | |
| Luminex testing (per test) | 1600 | 500–2000 | |
| Treatment of acute rejection: ABMR | 18 308 | 10 000–30 000 | |
| Treatment of acute rejection: TCMR (steroid responsive) | 6030 | 5000–10 000 | |
| Treatment of acute rejection: TCMR (steroid resistant) | 43 330 | 30 000–50 000 | |
| Treatment using IVIG | 4032 | 2000–10 000 | |
| Discount costs | 0.05 | 0.03–0.08 | |
| Distributions | |||
| Prevalence of viremia | 0.18 (0.001) | Normal (mean, SD) | |
| Probability of graft loss in the no-screen arm | 0.46 (0.05) | Normal (mean, SD) | 26 |
| Probability of graft dysfunction in patients with PyVAN | 0.1 (0.05) | Normal (mean, SD) | 29,30,39 |
| Probability of retransplantation | 0.1 (0.05) | Normal (mean, SD) | 43 |
| Probability of death in patients with PyVAN | 0.0225 (0.005) | Normal (mean, SD) | 29 |
| Costs of transplant: subsequent years, $ (AUD) | 18 864 (0.85) | γ (α, λ) | |
| Costs of dialysis: return to dialysis after allograft loss, $ (AUD) | 113 932 (0.85) | γ (α, λ) |
AUD, Australian dollars; ABMR, antibody mediated rejection; BKVAN, BK virus-associated nephropathy; DSA, donor-specific antibody; PCR, polymerase chain reaction; PyVAN, polyomavirus-associated nephropathy; TCMR, T-cell mediated rejection.