title: A cost-effectiveness analysis of OKT3 induction therapy in cadaveric kidney transplantation.
abstract: We evaluated the cost-effectiveness of a standard immunosuppressive regimen versus an OKT3 induction regimen in cadaveric kidney transplant recipients. Cost estimates were based on results from a five-center randomized trial comparing the safety and efficacy of OKT3 induction with a conventional triple-drug regimen and financial data from the National Cooperative Transplantation Study, the Medicare Provider and Analysis Review database, and other sources. Patients received OKT3 (5 mg/day) by intravenous (IV) bolus injection for 10 to 14 consecutive days in conjunction with azathioprine, prednisone, and the delayed addition of cyclosporine (CsA) on day 11 (n = 105) or a conventional immunosuppressive regimen consisting of CsA, azathioprine, and prednisone (n = 102). The following measures were used to evaluate the two regimens: costs incurred between transplantation and graft failure; the effectiveness of the two regimens as defined by length of graft survival; and cost-effectiveness ratios through 5 years of observed follow-up and modeled through the expected duration of graft survival. Results showed that OKT3 induction uniformly adds $8,219 to the cost of the transplant hospitalization. However, most of this cost is offset by a reduction in the cost of treating rejection episodes in the OKT3 group (P = 0.002). A trend toward improved graft survival was detected in the OKT3 group (P = 0.158). Through 5 years of observed follow-up, costs per year of graft survival are $30,474 with OKT3 versus $32,687 with the conventional regimen. Modeled through the expected duration of graft survival, OKT3 induction costs $8,335 for each additional year of graft survival. Results are fairly insensitive to wide variations in baseline assumptions. We conclude that OKT3 induction improves the cost-effectiveness of kidney transplantation.
authors.affiliation: Department of Organ Transplantation, Via Christi Regional Medical Center, Wichita, KS 67214, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Shield
authors.forename: R J
authors.initials: RJ
authors.lastname: Jacobs
authors.forename: S
authors.initials: S
authors.lastname: Wyant
authors.forename: A
authors.initials: A
authors.lastname: Das
mesh_terms: D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage / Q000191:economics; D002102:Cadaver; D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000008:administration & dosage / Q000191:economics; D016527:Drug Costs; D006084:Graft Rejection / Q000191:economics; D006085:Graft Survival; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000191:economics*; D016030:Kidney Transplantation / Q000191:economics* / Q000276:immunology; D016853:Muromonab-CD3 / Q000008:administration & dosage / Q000191:economics*; D009894:Opportunistic Infections / Q000188:drug therapy / Q000191:economics; D011241:Prednisone / Q000008:administration & dosage / Q000191:economics
chemical_list: D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone