ECONOMICS OF THYMOGLOBULIN VERSUS ATGAM FOR INDUCTION IMMUNOSUPPRESSION IN RENAL TRANSPLANTATION

Abstract

578 The optimal immunosuppression regimen in renal transplantation is unknown. Here we consider the economic implications of the use of two alternative polyclonal antilymphocyte preparations for induction in renal transplant recipients, Thymoglobulin and Atgam. Methods: 72 renal transplant patients were enrolled consecutively at one center in a randomized double-blinded clinical trial and received either Thymoglobulin (48 pts.) or Atgam (24 pts.) for induction immunosuppression. There were no differences in the donor or recipient characteristics of the two groups. The center's internal cost accounting system was used to determine the cost of all hospitalizations. The costs of Thymoglobulin and Atgam were excluded from analysis and will be included when a market price for Thymoglobulin is announced. Results: The average cost of the transplant stay was similar in the two groups: Thymoglobulin $26,555 and Atgam $25,914 (p=0.747). However, average hospital costs after the transplant stay, depicted below, were remarkably different. (Figure)FigureBy one year, post-transplant average hospital cost in the two groups were: Thymoglobulin $6,192 and Atgam $13,114 (p=0.004) This result is largely due to differences in acute rejection and CMV-disease rates in the two groups: Rejection: Thymoglobulin 4% and Atgam 25% (p=0.014); CMV-disease: Thymoglobulin 10% and Atgam 33% (p=0.025). Conclusion: Patients that received Thymoglobulin compared to Atgam experienced fewer post-transplant adverse events. This lead to lower post-transplant hospital costs in patients treated with Thymoglobulin.