TY - JOUR
T1 - Economic impacts of alternative kidney transplant immunosuppression
T2 - A national cohort study
AU - Axelrod, David A.
AU - Caliskan, Yasar
AU - Schnitzler, Mark A.
AU - Xiao, Huiling
AU - Dharnidharka, Vikas R.
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara
AU - Brennan, Daniel C.
AU - Randall, Henry
AU - Alhamad, Tarek
AU - Kasiske, Bertram L.
AU - Hess, Gregory
AU - Lentine, Krista L.
N1 - Funding Information:
This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-DK102981 and R01-DK120518. KLL receives support from the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, and ELS, for manuscript editing.
Funding Information:
This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government‐sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01‐DK102981 and R01‐DK120518. KLL receives support from the Mid‐America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, and ELS, for manuscript editing.
Publisher Copyright:
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Understanding the economic implications of induction and maintenance immunosuppression (ISx) is important in developing personalized kidney transplant (KTx) care. Using data from a novel integrated data set including financial records from the University Health System Consortium, Medicare, and pharmacy claims (2007-2014), we estimated the differences in the impact of induction and maintenance ISx regimens on transplant hospitalization costs and Medicare payments from KTx to 3 years. Use of thymoglobulin (TMG) significantly increased transplant hospitalization costs ($12 006; P =.02), compared with alemtuzumab and basiliximab. TMG resulted in lower Medicare payments in posttransplant years 1 (−$2058; P =.05) and 2 (−$1784; P =.048). Patients on steroid-sparing ISx incurred relatively lower total Medicare spending (−$10 880; P =.01) compared with patients on triple therapy (tacrolimus, antimetabolite, and steroids). MPA/AZA-sparing, mammalian target of rapamycin inhibitors-based, and cyclosporine-based maintenance ISx regimens were associated with significantly higher payments. Alternative ISx regimens were associated with different KTx hospitalization costs and longer-term payments. Future studies of clinical efficacy should also consider cost impacts to define the economic effectiveness of alternative ISx regimens.
AB - Understanding the economic implications of induction and maintenance immunosuppression (ISx) is important in developing personalized kidney transplant (KTx) care. Using data from a novel integrated data set including financial records from the University Health System Consortium, Medicare, and pharmacy claims (2007-2014), we estimated the differences in the impact of induction and maintenance ISx regimens on transplant hospitalization costs and Medicare payments from KTx to 3 years. Use of thymoglobulin (TMG) significantly increased transplant hospitalization costs ($12 006; P =.02), compared with alemtuzumab and basiliximab. TMG resulted in lower Medicare payments in posttransplant years 1 (−$2058; P =.05) and 2 (−$1784; P =.048). Patients on steroid-sparing ISx incurred relatively lower total Medicare spending (−$10 880; P =.01) compared with patients on triple therapy (tacrolimus, antimetabolite, and steroids). MPA/AZA-sparing, mammalian target of rapamycin inhibitors-based, and cyclosporine-based maintenance ISx regimens were associated with significantly higher payments. Alternative ISx regimens were associated with different KTx hospitalization costs and longer-term payments. Future studies of clinical efficacy should also consider cost impacts to define the economic effectiveness of alternative ISx regimens.
KW - economics
KW - health expenditures
KW - induction immunosuppression
KW - kidney transplantation
KW - maintenance immunosuppression
KW - registries
UR - http://www.scopus.com/inward/record.url?scp=85081374963&partnerID=8YFLogxK
U2 - 10.1111/ctr.13813
DO - 10.1111/ctr.13813
M3 - Article
C2 - 32027049
AN - SCOPUS:85081374963
SN - 0902-0063
VL - 34
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 4
M1 - e13813
ER -