Cost-Effectiveness of the Kidney Transplant Compared With Hemodialysis in End-Stage Renal Disease in Dubai, the United Arab Emirates: A Cost-Utility Study

Objectives: This study aims to examine the cost-effectiveness of renal transplantation and hemodialysis among patients with end-stage renal disease in Dubai, the United Arab Emirates. Methods: A Markov model was developed to examine the cost-effectiveness of hemodialysis and renal transplant over a 5-year time horizon from the payer perspective, using empirical data on treatment costs from private hospitals in Dubai, utilities from Tufts Cost-Effectiveness Analysis Registry, and transition probabilities from European Renal Association-European Dialysis and Transplant Association registry data. Results: In the base-case analysis, the discounted average total cost for 5 years was AED 961, 323 ($261 941) for transplantation and AED 971 538 ($264 724) for hemodialysis, with 3.4 and 2.1 quality-adjusted life years (QALY), respectively. The costs of first-year transplant and hemodialysis were AED 470 000 ($128 065) and AED 276 000 ($75 204) with 0.72 and 0.55 QALY, respectively. Transplantation became the dominant treatment strategy by the fourth year and was a cost-effective alternative from the second year on with an incremental cost-effectiveness ratio of AED 53 205 ($14 497 per QALY) (for a cost difference of AED 36 712 ($10 003) and QALY gain of 0.69). Conclusions: Although the cost of the first year after transplantation was high, transplantation was more effective than hemodialysis over 2 years and was less costly over a longer period. The study suggests that performing renal transplants for patients with end-stage renal disease is more cost-effective than hemodialysis.