Economics of the Antithymocyte Globulins Thymoglobulin(R) and Atgam(R) in the Treatment of Acute Renal Transplant Rejection
Mark A. Schnitzler
Robert S. Woodward
Jeffrey A. Lowell
Timothy J. Schroeder
Gary G. Singer
Daniel C. Brennan
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(R) or Atgam(R). Design and setting: This was a cost analysis of a randomised double-blind multicentre clinical trial comparing the safety and efficacy of Thymoglobulin(R) and Atgam(R) 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(R) arm and 81 in the Atgam(R) 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(R) (1.5 mg/kg/day) for an average of 10 days or intravenous Atgam(R) (15 mg/kg/day) for an average of 9.7 days. Results: On average, Thymoglobulin(R) provided significant cost savings compared with Atgam(R) 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(R) 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(R) is a cost saving strategy when compared with treatment with Atgam(R).
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