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Cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation

Published online by Cambridge University Press:  04 July 2008

Jean-Blaise Wasserfallen ,
Mira Kast-Brückner ,
Oriol Manuel ,
Jean-Pierre Venetz ,
Pascal R. A. Meylan  and
Manuel Pascual
Jean-Blaise Wasserfallen
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Mira Kast-Brückner
Affiliation:
University of Lausanne
Oriol Manuel
Affiliation:
University of Lausanne
Jean-Pierre Venetz
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Pascal R. A. Meylan
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Manuel Pascual
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
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Abstract

Objectives: The aims of this study were to assess the 1-year cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation to prevent both rejection and infectious complications.

Methods: Patients (pts) transplanted from January 2000 to March 2003 (Group A) and treated with a conventional protocol were compared with pts submitted to a combined regimen including universal cytomegalovirus (CMV) prophylaxis between April 2003 and July 2005 (Group B). Costs were computed from the hospital accounting system for hospital stays, and official tariffs for outpatient visits. Patients with incomplete costs data were excluded from analysis.

Results: Fifty-three patients were analyzed in Group A, and 60 in Group B. Baseline characteristics including CMV serostatus were not significantly different between the two groups. Over 12 months after transplantation, acute rejections decreased from 41.5 percent in Group A to 6.7 percent in Group B (p < .001), and CMV infections from 47 percent to 15 percent (p < .001). Overall, readmissions decreased from 68 percent to 55 percent (p = .160), and average hospital days from 28 ± 19 to 20 ± 11 days (p < .007). The average number of outpatient visits decreased from 49 ± 10 to 39 ± 8 (p < .001). Average 1-year immunosuppressive and CMV prophylaxis costs (per patient) increased from CHF20,402 ± 7,273 to 27,375 ± 6,063 (p < .001), graft rejection costs decreased from CHF4,595 ± 10,182 to 650 ± 3,167 (p = .005), CMV treatment costs from CHF2,270 ± 6,161 to 101 ± 326 (p = .008), and outpatient visits costs from CHF8,466 ± 1’721 to 6,749 ± 1,159 (p < .001). Altogether, 1-year treatment costs decreased from CHF39’957 ± 16,573 to 36,204 ± 6,901 (p = .115).

Conclusions: The new combined regimen administered in Group B was significantly more effective, and its additional costs were more than offset by savings associated with complications avoidance.

Keywords

Cost-effectivenessImmunosuppressionGraft rejectionCMV infectionKidney transplantation
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 3 , July 2008 , pp. 312 - 317
Copyright
Copyright © Cambridge University Press 2008

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