Kidney Week

Abstract: SA-PO047

Economic Impacts of Alternative Kidney Transplant Immunosuppression: A National Cohort Study

Session Information

• Transplantation: Clinical Outcomes
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine,

• Axelrod, David A., Lahey Hospital and Clinic, Burlington, Massachusetts, United States

David A. Axelrod,

• Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States

Vikas R. Dharnidharka,

• Xiao, Huiling, St. Louis University, St. Louis, Missouri, United States

Huiling Xiao,

• Brennan, Daniel C., Johns Hopkins, Baltimore, Maryland, United States

Daniel C. Brennan,

• Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States

Dorry L. Segev,

• Ouseph, Rosemary, St Louis University, St Louis, Missouri, United States

Rosemary Ouseph,

• Randall, Henry B., SSM Health/SLUH, St. Louis, Missouri, United States

Henry B. Randall,

• Naik, Abhijit S., Unviersity of Michign, Ann Arbor, Michigan, United States

Abhijit S. Naik,

• Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada

Ngan Lam,

• Alhamad, Tarek, Washington University in St. Louis, St. Louis, Missouri, United States

Tarek Alhamad,

• Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States

Bertram L. Kasiske,

• Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Conshohocken, Pennsylvania, United States

Gregory P. Hess,

• Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States

Mark Schnitzler,

Background

Economic outcomes are increasingly considered along with clinical efficacy to guide choice of alternative therapies. We examined the cost impact of kidney transplant (KTx) induction and maintenance suppression (ISx) in a large national US cohort.

Methods

Cost data for the transplant hospitalization were drawn from linkage of the SRTR registry with financial records from the University HealthSystem Consortium of US academic hospitals (2002 –2013, N= 62,002 KTx). Cost of post-transplant care were estimated from Medicare Part A &B payments (N= 62,698). Marginal costs of induction (all periods) and maintenance (Yr 1, Yr 2, Yr 3) ISx were estimated from multivariate regression, including adjustment for baseline recipient, donor, and transplant factors.

Results

Compared to IL2rAb, Thymoglobulin (TMG, $10,066) and other induction ($21,627) was associated with increased costs of the transplant hospitalization, while Campath was initially cost saving ($4,208 . Subsequently, patients induced with TMG had significantly lower costs in Yr1 ($2,108) and Yr 2 ($1,834) post-KTx.

Compared to triple maintenance ISx, steroid-free recipients incurred lower costs in Yr 1 ($4,011), while all other maintenance regimens were associated with higher costs in Yr 1. Patients who received mTORi-based and CsA-based ISx continued to incur higher costs in Yrs 2 and 3 post-KTx. (Figure)

Conclusion

Induction and maintenance ISx are associated with differential costs of care during the transplant hospitalization and post-transplant periods, which may be mediated by different complication rates. Initial higher costs of TMG induction appear to be followed by later cost savings

Funding

• NIDDK Support