Authors: Schnitzler M.A.¹; Woodward R.S.¹; Lowell J.A.¹; Amir L.²; Schroeder T.J.³; Singer G.G.⁴; Brennan D.C.¹

Source: PharmacoEconomics, Volume 17, Number 3, 1 March 2000 , pp. 287-293(7)

Publisher: Adis International

Abstract:

Objective: To evaluate the economic implications for transplant centres, Medicare and society of treatment of corticosteroid-resistant Banff Grades I, II and III acute kidney transplant rejection with the antithymocyte globulins Thymoglobulin or Atgam.

Design and setting: This was a cost analysis of a randomised double-blind multicentre clinical trial comparing the safety and efficacy of Thymoglobulin and Atgam that was performed at 25 centres in the US in 1994 to 1996.

Patients and participants: The study enrolled 163 patients, 82 in the Thymoglobulin arm and 81 in the Atgam arm.

Methods: Estimates of the cost of care from the initiation of rejection therapy to 90 days post-therapy were derived from various publicly available sources and applied to patient-specific clinical events documented in the clinical trial. Patients received either intravenous Thymoglobulin (1.5 mg/kg/day) for an average of 10 days or intravenous Atgam (15 mg/kg/day) for an average of 9.7 days.

Results: On average, Thymoglobulin provided significant cost savings compared with Atgam from the perspective of society [$US5977 (1996 values); 95% confidence interval (CI) $US3719 to $US8254], Medicare ($US4967; 95% CI $US3256 to $US6678) and the transplant centre ($US3087; 95% CI $US1512 to $US4667). The overall advantage attributable to Thymoglobulin was primarily due to savings from fewer recurrent rejection treatments and less frequent return to dialysis.

Conclusions: Treatment of acute renal transplant rejection with Thymoglobulin is a cost saving strategy when compared with treatment with Atgam.

Keywords: Antithymocyte globulin Merieux, therapeutic use; Antithymocyte globulin Upjohn, therapeutic use; Cost analysis; Immunomodulators, therapeutic use; Pharmacoeconomics; Renal transplant rejection, treatment

Document Type: Original article

Affiliations: 1: Pharmaco-Economic Transplant Research, Washington University, St Louis, Missouri, USA 2: Quality Resource Management Inc., St Louis, Missouri, USA 3: Department of Pathology and Laboratory Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA 4: Department of Internal Medicine, Washington University, St Louis, Missouri, USA

Publication date: 2000-03-01

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