Table S1. Clinical outcomes of the acceptable mismatch allocation model.

Transcription

1 Table S1. Clinical outcomes of the acceptable mismatch allocation model. Recipient Age PRA Waiting Time (months) HLA mismatch (A/B/DR) HLAMatchmaker acceptable mismatch (years) (%) Actual Simulation Change Actual Simulation HLA Eplet mismatches /0/1 2/2/0 B st Reallocated /1/1/ 1/2/0 2 nd Reallocated /1/1 1/1/0 3 rd Reallocated /1/1 0/2/ /0/2 1/2/2 B st Reallocated /1/1 0/2/2 2 nd Reallocated /1/1 1/2/1 3 rd Reallocated /1/1 2/1/ /1/1 0/1/2 B st Reallocated /0/2 2/1/1 2 nd Reallocated /2/1 2/2/2 3 rd Reallocated /2/1 2/1/ /1/0 2/1/1 DR13 2 NA 1 st Reallocated /2/2 1/2/2 2 nd Reallocated /1/1 1/1/1 3 rd Reallocated /1/1 1/2/1 Luminex MFI

2 Table S2. Australian National Matching Score Calculation (1) Australian National Matching Score Base score if (HLA A + B + DR mismatches = 0) and (Class 1 authorised Panel Reactive Antibodies not < 50%) (Level 1 match) Base score if (HLA A + B + DR mismatches = 1) and (Class 1 authorised Panel Reactive Antibodies > 80%) (Level 2 match) Base score if (HLA A + B + DR mismatches = 2) and (Class 1 authorised Panel Reactive Antibodies > 80%) (Level 3 match) Base score if (HLA A + B + DR mismatches = 0) and (Class 1 authorised Panel Reactive Antibodies < 50%) (Level 4 match) Base score if (HLA DR mismatches = 0) and (HLA A + B mismatches = 1) and (Class 1 authorised Panel Reactive Antibodies not > 80%) and centre credit difference (donor centre credit patient centre credit) 3 (Level 5 match) Base score if (HLA DR mismatches = 0) and (HLA A + B mismatches = 2) and (Class 1 authorised Panel Reactive Antibodies not > 80%) and centre credit difference (donor centre credit patient centre credit) 6 (Level 6 match) 60,000,000 59,000,000 58,000,000 57,000,000 56,000,000 55,000,000 Base score if score is null and centre credit difference (donor centre credit patient centre credit) < 20 (Level 7 match) Paediatric +30,000 If donor centre = patient centre +50,000 Centre credit balance +(1,000 + patient centre credit) Each month Waiting on dialysis +1 Lower threshold for National Algorithm 54,000,000

3 Reference 1. The Transplant Society of Australia and New Zealand. Organ transplantation from deceased donors consensus statement on eligibility criteria and allocation protocols; 2011 [cited 2012 June 01]; Available from:

4 Table S3. Western Australian Matching Score Calculation (1) Western Australian Matching Score Base Score +40,000,000 Each HLA-DR mismatch -5,000,000 Each HLA-B mismatch -3,000,000 Each HLA-A mismatch -3,000,000 If homozygous at DR and waiting more than 5 years +5,000,000 Each month Waiting on dialysis +100,000 Reference 1. The Transplant Society of Australia and New Zealand. Organ transplantation from deceased donors consensus statement on eligibility criteria and allocation protocols; 2011 [cited 2012 June 01]; Available from:

5 Figure S1. Simplified structure and health states in the Markov models.

6 Table S4. Clinical parameter estimates in the Markov model. Clinical data Base-case value (range used in sensitivity analysis References Probability of transplantation Highly-sensitised patient NOMS (unpublished) Reallocated patient Proportion of highly-sensitised benefiting Allocation model simulation Proportion of reallocated affected Allocation model simulation Likelihood ratio of transplantation for highly-sensitised 1.40 ( ) Allocation model simulation Likelihood ratio of transplantation for reallocated 1.49 ( ) Allocation model simulation Age-specific all-cause mortality among patients on dialysis Age-specific all-cause mortality among patients on the waiting list Age-specific all-cause mortality among transplant recipients Hazard ratio for death after transplantation if PRA>80% Ages (1) Ages (1) Ages (1) ( ) ANZDATA (unpublished) Discount rate Benefits 0.05 ( ) (2) Costs 0.05 ( ) (2) References 1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England Journal of Medicine 1999; 341(23): Commonwealth Department of Health and Ageing. Guidelines for the pharmaceutical industry on the preparation of submissions to the Pharmaceutical Benefits Advisory Committee Canberra, ACT: Commonwealth Department of Health and Ageing.

7 Table S5. Cost parameter estimates in the Markov model. Cost data Base-case value (range used in sensitivity analysis References Dialysis Proportion In-centre haemodialysis $76,881 (1) Satellite haemodialysis $63,505 Home haemodialysis $47,775 Peritoneal dialysis $51,640 Transplantation (initial year 1) (1,2) Transplant procedure (recipient hospital) $34,581 Transplant procedure (donor hospital) $3,000 Induction therapy (Basiliximab) $6,300 Outpatient follow-up (36 visits) $15,192 Transplantation (after year 1) Immunosuppression (3) Azathioprine $1, Cyclosporine $8, Tacrolimus $20, Mycophenolate mofetil $6, Mycophenolic acid $6, Sirolimus $14, Everolimus $9, Prednisolone $ Proportion of immunosuppression used (2) Year 1 Azathioprine 0.00 Cyclosporine 0.14 Tacrolimus 0.86 Mycophenolate mofetil 0.89 Mycophenolic acid 0.08 Sirolimus 0.01 Everolimus 0.01 Prednisolone 1.00 Subsequent years Azathioprine 0.06 Cyclosporine 0.23 Tacrolimus 0.67 Mycophenolate mofetil 0.78 Mycophenolic acid 0.11 Sirolimus 0.03 Everolimus 0.03 Prednisolone 0.92 Cost of death (1,2) Hospitalisation (14 days) $7,457 Medications (morphine, $11,271 prochlorperazine, metoclopramide, ondansetron, largactil, hyoscine)

8 References 1. Australian Government Department of Health and Ageing. Cost Report Round 14 version 6.0; 2012 Apr. 2. Australian Government Department of Health and Ageing. Pharmaceutical Benefits Scheme (PBS) [cited /11/2012]; Available from: 3. Clayton P, Campbell S, Hurst K, McDonald S, Chadban S. The 35 th Annual ANZDATA Report 2012: Chapter 8 Transplantation; 2012 June.