Economics of the antithymocyte globulins Thymoglobulin and Atgam in the treatment of acute renal transplant rejection.
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.


METHODS
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.


METHODS
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.
Schnitzler
M A
MA
Pharmaco-Economic Transplant Research, Washington University, St Louis, Missouri, USA. schnitz@wueconc.wustl.edu
Woodward
R S
RS
Lowell
J A
JA
Amir
L
L
Schroeder
T J
TJ
Singer
G G
GG
Brennan
D C
DC
D000208:Acute Disease; D000328:Adult; D000961:Antilymphocyte Serum / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D005260:Female; D006084:Graft Rejection / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics* / Q000276:immunology*; D008297:Male
D000961:Antilymphocyte Serum