Abstract Type : Oral presentation
Abstract Submission No.: A-0959
Abstract Topic : Transplantation

Long-term Economic Evaluation of Kidney Transplantation versus Dialysis: A 21-Year Nationwide Population-Based Analysis

Heajung Lee¹, Eunjeong Kang⁷, Minsang Kim², Jeongin Song³, Subin Jeong⁴, Sohn Hojoon⁵, Hajeong Lee⁶
¹Department of Department of Statistics and Data Science, Yonsei University, Korea, Republic of
²Department of Transplantation Center, Seoul National University Hospital, Korea, Republic of
³Department of Internal Medicine-Nephrology, Seoul National University Hospital, Korea, Republic of
⁴Department of Internal Medicine, Dongguk University Ilsan Hospital, Korea, Republic of
⁵Department of Biomedical Research Institute, Seoul National University Hospital, Korea, Republic of
⁶Department of Preventive Medicine, Seoul National University College of Medicine, Korea, Republic of
⁷Department of Internal Medicine-Nephrology, Seoul National University College of Medicine, Korea, Republic of

Objectives : We aimed to analyze the long-term economic trajectory and identify the break-even point where the cumulative cost of KT becomes lower than that of maintenance dialysis using nationwide population-based data.
Methods : We identified KT recipients and dialysis patients from the NHIS database (2002-2023). To ensure comparability, exact 1:1 matching was performed. A total of 10,740 matched pairs were analyzed. Annual and cumulative direct medical costs were tracked for up to 16 years, including 5 years of pre-index expenditure.
Results : In the first post-transplant year, KT recipients incurred higher annual costs compared to dialysis patients ($30,295 vs. $20,623; p < 0.001). However, starting from the second post-transplant year, annual costs for dialysis patients were significantly higher. The cost ratio was 2.76 within the second post-transplant year ($23,893 vs. $8,694) and widened to 3.53 within the fourth post-transplant year ($27,488 vs. $7,837; p < 0.001). When evaluating cumulative costs starting from five years pre-index, the economic break-even point was reached within the third post-transplant year, where the total expenditure for the dialysis group ($112,001) surpassed that of the KT group ($105,985; p < 0.001). Subgroup analysis revealed that 54.9% of KT recipients achieved an early break-even within the third post-transplant year. Compared to the late break-even group, this early group was significantly younger (mean 47.5 vs. 50.2 years), had a significantly lower comorbidity burden (CCI <= 2: 25.3% vs. 16.4%), and a higher proportion of patients in the highest income quintile (34.9% vs. 29.1%).
Conclusions : KT demonstrates long-term economic efficiency, offsetting high initial costs within the third post-transplant year compared to dialysis. Patients with lower age and comorbidity burden achieve financial benefits more rapidly. These findings provide a strong economic rationale for prioritizing KT to ensure the long-term sustainability of healthcare resources.