{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T16:41:37Z","timestamp":1793292097636,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess the economic benefit and payback period of kidney transplantation compared to maintenance dialysis across 14 European Union countries (2019 and 2023), with a focus on living-donor transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A longitudinal country panel was compiled from European registry and national report. Cost\u2013benefit analysis calculated annual net savings and break-even time, and cost-utility analysis estimated quality-adjusted life year gains using published utility weights with survival adjustment. A Graph-Regularized Neural Ordinary Differential Equations framework was introduced to capture nonlinear temporal dynamics and cross-country interactions, and its predictive performance was benchmarked compared against linear cost\u2013benefit calculations and two-way fixed-effects regression using root mean squared error.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Transplantation was economically dominant in all country-years. Mean annual net savings were $37,471 and mean break-even time was 3.12\u202fyears (0.5\u20136.8). Incremental quality-adjusted life years averaged 4.38. Countries with living-donor share above 20% had shorter payback than those at or below 20% (2.01 vs. 4.28\u202fyears). The findings support the widespread economic superiority of transplantation over dialysis across the healthcare systems of all nations under investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Living kidney transplantation consistently offers cost savings and health benefits across all health systems in the European Union. However, its scalability depends on country-specific payback periods, which are primarily influenced by upfront transplant costs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1801439","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:43:24Z","timestamp":1773125004000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Kidney transplantation versus maintenance dialysis in 14 EU countries: cost savings, payback time, and budget impact"],"prefix":"10.3389","volume":"14","author":[{"given":"Horia","family":"Iuga","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Iuliu Ha\u021bieganu University of Medicine and Pharmacy","place":["Cluj-Napoca, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Ali","family":"Balc\u0131","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Faculty of Science, Mugla Sitki Kocman University","place":["Mugla, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simion","family":"Mihon","sequence":"additional","affiliation":[{"name":"Department of Finance-Accounting, \u201c1 Decembrie 1918\u201d University of Alba Iulia","place":["Alba Iulia, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6mer","family":"Akg\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Faculty of Science, Mugla Sitki Kocman University","place":["Mugla, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin Ioan","family":"Elec","sequence":"additional","affiliation":[{"name":"Department of Urology, Iuliu Ha\u021bieganu University of Medicine and Pharmacy","place":["Cluj-Napoca, Romania"]},{"name":"Clinical Institute of Urology and Renal Transplantation","place":["Cluj-Napoca, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"ref1","volume-title":"Registry: ERA-EDTA Registry Annual Report 2019","author":"Jager","year":"2019"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1093\/ckj\/sfab070","article-title":"Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney","volume":"14","author":"Vanholder","year":"2021","journal-title":"Clin Kidney J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"395","author":"Bikbov","year":"2020","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"414","DOI":"10.2471\/BLT.17.206441","article-title":"The global burden of kidney disease and the sustainable development goals","volume":"96","author":"Luyckx","year":"2018","journal-title":"Bull World Health Organ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1093\/ckj\/sfx088","article-title":"Do kidney transplantations save money? A study using a before\u2013after design and multiple register-based data from Sweden","volume":"11","author":"Jarl","year":"2018","journal-title":"Clin Kidney J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0220800","DOI":"10.1371\/journal.pone.0220800","article-title":"Healthcare costs of patients on different renal replacement modalities\u2014analysis of Dutch health insurance claims data","volume":"14","author":"Mohnen","year":"2019","journal-title":"PLoS One"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"101347","DOI":"10.1016\/j.lanepe.2025.101347","article-title":"A call for urgent action on chronic kidney disease across Europe","volume":"54","author":"Ferro","year":"2025","journal-title":"Lancet Regional Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e079937","DOI":"10.1136\/bmj-2024-079937","article-title":"Progress of nations in the organisation of, and structures for, kidney care delivery between 2019 and 2023: cross sectional survey in 148 countries","volume":"387","author":"Okpechi","year":"2024","journal-title":"BMJ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"203","DOI":"10.3390\/kidneydial4040017","article-title":"Costs analysis of kidney transplantation in Spain: differences between regional health services","volume":"4","author":"Ag\u00fcero-Cobo","year":"2024","journal-title":"Kidney Dialysis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"883","DOI":"10.2147\/CEOR.S559471","article-title":"Cost-utility analyses of hemodialysis, peritoneal dialysis, and kidney transplantation in patients with end-stage kidney disease: a systematic review","volume":"17","author":"Wulandari","year":"2025","journal-title":"ClinicoEconomics Outcomes Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e068769","DOI":"10.1136\/bmj-2021-068769","article-title":"Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis","volume":"376","author":"Chaudhry","year":"2022","journal-title":"BMJ"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1551","DOI":"10.1016\/j.ajt.2023.07.006","article-title":"Survival after kidney transplantation compared with ongoing dialysis for people over 70 years of age: a matched-pair analysis","volume":"23","author":"Shi","year":"2023","journal-title":"Am J Transplant"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2327","DOI":"10.1093\/ndt\/gfab232","article-title":"Mapping health-related quality of life after kidney transplantation by group comparisons: a systematic review","volume":"36","author":"Wang","year":"2021","journal-title":"Nephrol Dialysis Transpl"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"10730","DOI":"10.1038\/s41598-023-37814-6","article-title":"Healthcare costs after kidney transplantation compared to dialysis based on propensity score methods and real world longitudinal register data from Sweden","volume":"13","author":"Zhang","year":"2023","journal-title":"Sci Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1222069","DOI":"10.3389\/fpubh.2023.1222069","article-title":"Health economics aspects of kidney transplantation in Sicily: a benchmark analysis on activity and estimated savings","volume":"11","author":"Cacciola","year":"2023","journal-title":"Front Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"23018","DOI":"10.1038\/s41598-024-73735-8","article-title":"A systematic review and quality assessment of economic evaluations of kidney replacement therapies in end-stage kidney disease","volume":"14","author":"Nyokabi","year":"2024","journal-title":"Sci Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1528","DOI":"10.1093\/ndt\/gfac333","article-title":"Trends in kidney transplantation rate across Europe: study from the ERA registry","volume":"38","author":"Boenink","year":"2023","journal-title":"Nephrol Dialysis Transpl"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1016\/j.healthpol.2022.07.011","article-title":"Induced demand in kidney replacement therapy","volume":"126","author":"Redeker","year":"2022","journal-title":"Health Policy"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12913-022-08974-4","article-title":"Payment systems for dialysis and their effects: a scoping review","volume":"23","author":"Emrani","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e057107","DOI":"10.1136\/bmjopen-2021-057107","article-title":"Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study","volume":"12","author":"Molina-P\u00e9rez","year":"2022","journal-title":"BMJ Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"13452","DOI":"10.3389\/ti.2024.13452","article-title":"Benefits of living over deceased donor kidney transplantation in elderly recipients: a propensity score matched analysis of a large European registry cohort","volume":"37","author":"Toapanta","year":"2024","journal-title":"Transpl Int"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1124453","DOI":"10.3389\/fpubh.2023.1124453","article-title":"Pre-emptive living donor kidney transplantation: a public health justification to change the default","volume":"11","author":"Kim","year":"2023","journal-title":"Front Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1168","DOI":"10.1111\/ajt.14702","article-title":"An economic assessment of contemporary kidney transplant practice","volume":"18","author":"Axelrod","year":"2018","journal-title":"Am J Transplant"},{"key":"ref24","volume-title":"Advances in Neural Information Processing Systems","author":"Chen","year":"2018"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0167-6296(96)00506-1","article-title":"Economic foundations of cost-effectiveness analysis","volume":"16","author":"Garber","year":"1997","journal-title":"J Health Econ"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1038\/ki.1996.307","article-title":"A study of the quality of life and cost-utility of renal transplantation","volume":"50","author":"Laupacis","year":"1996","journal-title":"Kidney Int"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jval.2021.11.1351","article-title":"Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"25","author":"Husereau","year":"2022","journal-title":"Value Health"},{"key":"ref28","volume-title":"Global Observatory on Donation and Transplantation","year":"2023"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N Engl J Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1111\/j.1600-6143.2011.03686.x","article-title":"Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes","volume":"11","author":"Tonelli","year":"2011","journal-title":"Am J Transplant"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e29591","DOI":"10.1371\/journal.pone.0029591","article-title":"Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities","volume":"7","author":"Wong","year":"2012","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/ajt.13195","article-title":"OPTN\/SRTR 2013 annual data report: kidney","volume":"15","author":"Matas","year":"2015","journal-title":"Am J Transplant"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1801439\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T06:43:26Z","timestamp":1773125006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1801439\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":34,"alternative-id":["10.3389\/fpubh.2026.1801439"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1801439","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]},"article-number":"1801439"}}