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Quantifying the Treatment Effect of Kidney Transplantation Relative to Dialysis on Survival Time: New Results Based on Propensity Score Weighting and Longitudinal Observational Data from Sweden

Author

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  • Ye Zhang

    (School of Sociology and Population Studies, Renmin University of China, Beijing 100872, China
    Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, 22381 Lund, Sweden)

  • Ulf-G. Gerdtham

    (Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, 22381 Lund, Sweden
    Department of Economics, Lund University, 22363 Lund, Sweden
    Centre for Economic Demography, Lund University, 22363 Lund, Sweden)

  • Helena Rydell

    (Department of Clinical Sciences Intervention and Technology, Karolinska Institute, 17177 Huddinge, Sweden
    Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, 55185 Jönköping, Sweden)

  • Johan Jarl

    (Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, 22381 Lund, Sweden)

Abstract

Using observational data to assess the treatment effects on outcomes of kidney transplantation relative to dialysis for patients on renal replacement therapy is challenging due to the non-random selection into treatment. This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2−25.0) and 9.3 years (95% CI: 7.8−10.8) for kidney transplantation and dialysis, respectively. The survival advantage of kidney transplantation compared with dialysis was estimated to 13.8 years (95% CI: 11.4−16.2). There was no significant difference in the survival advantage of transplantation between men and women. Controlling for possible immortality bias reduced the survival advantage to 9.1–9.9 years. Our results suggest that kidney transplantation substantially increases survival time compared with dialysis in Sweden and that this consequence of treatment is equally distributed over sex.

Suggested Citation

  • Ye Zhang & Ulf-G. Gerdtham & Helena Rydell & Johan Jarl, 2020. "Quantifying the Treatment Effect of Kidney Transplantation Relative to Dialysis on Survival Time: New Results Based on Propensity Score Weighting and Longitudinal Observational Data from Sweden," IJERPH, MDPI, vol. 17(19), pages 1-13, October.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:19:p:7318-:d:424591
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    References listed on IDEAS

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    1. Björn Wikström & Michael Fored & Margaret Eichleay & Stefan Jacobson, 2007. "The financing and organization of medical care for patients with end-stage renal disease in Sweden," International Journal of Health Economics and Management, Springer, vol. 7(4), pages 269-281, December.
    2. Wooldridge, Jeffrey M., 2007. "Inverse probability weighted estimation for general missing data problems," Journal of Econometrics, Elsevier, vol. 141(2), pages 1281-1301, December.
    3. Peter C. Austin, 2009. "The Relative Ability of Different Propensity Score Methods to Balance Measured Covariates Between Treated and Untreated Subjects in Observational Studies," Medical Decision Making, , vol. 29(6), pages 661-677, November.
    4. Daryl Pregibon, 1980. "Goodness of Link Tests for Generalized Linear Models," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 29(1), pages 15-24, March.
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    1. Latame Adoli & Maxime Raffray & Valérie Châtelet & Cécile Vigneau & Thierry Lobbedez & Fei Gao & Florian Bayer & Arnaud Campéon & Elsa Vabret & Laëtitia Laude & Jean-Philippe Jais & Eric Daugas & Céci, 2022. "Women’s Access to Kidney Transplantation in France: A Mixed Methods Research Protocol," IJERPH, MDPI, vol. 19(20), pages 1-12, October.

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