P147 Decreasing medicare cost by tailoring single antigen test utilization on renal allocation score

Aim There are currently 95,121 patients awaiting a renal transplant in the US (UNOS data). The average cost of combined testing for HLA class I and II by single antigen (SA) is around $900. If all renal patients were screened monthly this would translate in over $1 billion in annual Medicare costs. We investigated whether cost saving could be achieved by devising a test utilization strategy based on patients’ UNOS status and allocation score. Methods First, we performed a query in UNET to obtain the renal allocation score and status (1 active or 7 inactive) of all renal transplant patients listed at our center. Second, we performed a search of all kidneys allocated by our OPO in the last 3 months to determine what allocation category and patient renal allocation score received the kidneys. Results Of the 588 patients on our waitlist, 65.3% were listed active and 34.7% were listed inactive. The average allocation score for kidneys placed by our OPO in the last 3 months was 7.27 for the first allocated kidney and 5.64 for the second kidney (scores above 15 were excluded). 8.4% of first allocated kidneys were transplanted in patients with scores below 4. These included ABO incompatible (A2 into B), 0-ABDR mismatch, and pediatric patients. Only one kidney with a KDPI of 35–85% was allocated to a patient with less than 4 points. A greater proportion of second kidneys were transplanted in patients with lower scores particularly 86–100 KDPI kidneys, kidney with long ischemic times, and high risk donors. Based on these results we developed a testing strategy whereby patients which are listed status 7 do not get tested by SA. Status 1 patients with less than 4 points are tested annually and those with more than 4 points are tested quarterly. Utilization of this testing strategy has resulted in a saving of 87.9% vs monthly testing. Conclusions It is possible to devise an SA test utilization strategy based on the listing status and allocation score of renal patients. We recognize that this approach may need to be tailored to each center depending on local allocation data and each center’s transplant practice. However, using such strategy can significantly decrease Medicare cost. When compare to monthly screens, we calculated that if used nationwide our approach could yield annual savings to Medicare of up to $902,810,700.