THE INCIDENCE AND COSTS OF STEROID-RELATED SIDE EFFECTS IN RENAL TRANSPLANTATION

Abstract

214 Steroids have been a mainstay of immunosuppressive therapy in renal transplantation. The incidence of side effects and associated costs have yet to be systematically assessed. Methods. We estimated the incidence and 10-year cost of treating steroid side effects for an average-sized center (performing 50 kidney transplants per year) using evidence-based literature analyses on the incidence and costs of such side effects. This evidence was used to construct a Markov cost model. Side effects included in the analysis were hypertension(and its complications), post-transplant diabetes mellitus (PTDM), peripheral bone fractures, osteonecrosis of the hip, and cataracts. The incremental influence of steroids on the incidence of side effects was derived from published studies of steroid withdrawal after transplantation. Results. Estimates of the steroid-related incidence of side effects and the cost of treatment for a cohort of 50 patients are as follows:TableHypertension and diabetes are the most costly side effects because of their relatively high incidence. Osteonecrosis of the hip, although rare, is expensive to treat. Conclusions. Steroid-related side effects are common in renal transplantation and add to the costs of transplant care. Evaluations of steroid-reduced immunosuppression protocols, and overall transplant results, should weigh not just the benefits, but the risks and costs of steroids.