Economic impacts of alternative kidney transplant immunosuppression: A national cohort study

David A. Axelrod, Yasar Caliskan, Mark A. Schnitzler, Huiling Xiao, Vikas R. Dharnidharka, Dorry L. Segev, Mara McAdams-DeMarco, Daniel C. Brennan, Henry Randall, Tarek Alhamad, Bertram L. Kasiske, Gregory Hess, Krista L. Lentine

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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.

Original languageEnglish
Article numbere13813
JournalClinical Transplantation
Issue number4
StatePublished - Apr 1 2020


  • economics
  • health expenditures
  • induction immunosuppression
  • kidney transplantation
  • maintenance immunosuppression
  • registries


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