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

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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 Luminex MFI

1 46 96 69 3

 66

2/0/1 2/2/0 B35 2 964

1

^st

Reallocated 52 0 36 57 + 21 1/1/1/ 1/2/0

2

^nd

Reallocated 13 0 1 21 + 20 1/1/1 1/1/0

3

^rd

Reallocated 23 66 48 53 + 5 1/1/1 0/2/1

2 33 94 144 129

 15

1/0/2 1/2/2 B51 2 340

1

^st

Reallocated 43 0 39 63 + 24 0/1/1 0/2/2

2

^nd

Reallocated 64 2 3 12 + 9 1/1/1 1/2/1

3

^rd

Reallocated 40 0 34 59 + 25 1/1/1 2/1/1

3 40 96 73 44

 29

0/1/1 0/1/2 B18 2 389

1

^st

Reallocated 33 94 144 148 + 4 1/0/2 2/1/1

2

^nd

Reallocated 36 62 117 118 + 1 1/2/1 2/2/2

3

^rd

Reallocated 70 0 55 69 + 14 2/2/1 2/1/1

4 51 84 58 33

 25

1/1/0 2/1/1 DR13 2 NA

1

^st

Reallocated 49 61 119 124 + 5 2/2/2 1/2/2

2

^nd

Reallocated 54 0 33 40 + 7 1/1/1 1/1/1

3

^rd

Reallocated 47 0 20 34 + 14 2/1/1 1/2/1

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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)

60,000,000

and (Class 1 authorised Panel Reactive Antibodies > 80%) (Level 2 match)

59,000,000

and (Class 1 authorised Panel Reactive Antibodies > 80%) (Level 3 match)

58,000,000

and (Class 1 authorised Panel Reactive Antibodies < 50%) (Level 4 match)

57,000,000

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)

56,000,000

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)

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

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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: http://www.tsanz.com.au/organallocationprotocols/.

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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: http://www.tsanz.com.au/organallocationprotocols/.

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

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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 0.154 NOMS (unpublished) Reallocated patient 0.846

Proportion of highly-sensitised benefiting 0.0130 Allocation model simulation Proportion of reallocated affected 0.0074 Allocation model simulation

Likelihood ratio of transplantation for highly-sensitised 1.40 (1.00-5.00) Allocation model simulation Likelihood ratio of transplantation for reallocated 1.49 (1.00-5.00) Allocation model simulation Age-specific all-cause mortality among patients on

dialysis

Ages (1)

0-19 0.036 20-39 0.086 40-59 0.133

≥60 0.232 Age-specific all-cause mortality among patients on the

waiting list

Ages (1)

0-19 0.022 20-39 0.043 40-59 0.065

≥60 0.100 Age-specific all-cause mortality among transplant

recipients Ages (1)

0-19 0.009 20-39 0.023 40-59 0.041

≥60 0.074 Hazard ratio for death after transplantation if

PRA>80%

1.526 (1.224-1.902) ANZDATA (unpublished)

Discount rate Benefits 0.05 (0.00-0.10) (2)

Costs 0.05 (0.00-0.10) (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): 1725-30.

2. Commonwealth Department of Health and Ageing. Guidelines for the pharmaceutical

industry on the preparation of submissions to the Pharmaceutical Benefits Advisory

Committee. 2006. Canberra, ACT: Commonwealth Department of Health and Ageing.

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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 0.219 $76,881 (1) Satellite haemodialysis 0.495 $63,505

Home haemodialysis 0.091 $47,775 Peritoneal dialysis 0.195 $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 $1,167.17

Cyclosporine $8,497.76

Tacrolimus $20,260.70

Mycophenolate mofetil $6,110.68

Mycophenolic acid $6,272.38

Sirolimus $14,717.09

Everolimus $9,948.09

Prednisolone $204.48

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,

prochlorperazine, metoclopramide, ondansetron, largactil, hyoscine)

$11,271

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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 2012 01/11/2012]; Available from:

http://www.pbs.gov.au/pbs/home.

3. Clayton P, Campbell S, Hurst K, McDonald S, Chadban S. The 35

^th

Annual ANZDATA

Report 2012: Chapter 8 Transplantation; 2012 June.