Cost-Effectiveness of Antibody-Based Induction Therapy in Deceased Donor Kidney Transplantation in the United States.
Cost-Effectiveness of Antibody-Based Induction Therapy in Deceased Donor Kidney Transplantation in the United States.
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DOI：
10.1097/tp.0000000000001310
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发表时间：
2017-06
期刊：
影响因子：
6.2
通讯作者：
Tanriover B
中科院分区：
文献类型：
--
作者：
Gharibi Z;Ayvaci MUS;Hahsler M;Giacoma T;Gaston RS;Tanriover B
Induction therapy in deceased donor kidney transplantation (DDKT) is costly, with wide discrepancy in utilization and a limited evidence base, particularly regarding cost-effectiveness. We linked the United States Renal Data System dataset to Medicare claims to estimate cumulative costs, graft survival, and incremental cost-effectiveness ratio (ICER –cost per additional year of graft survival) within 3 years of transplantation in 19,450 DDKT recipients with Medicare as primary payer from 2000 to 2008. We divided the study cohort into high-risk (age>60 years, panel reactive antibody>20%, African American race, Kidney Donor Profile Index>50%, cold ischemia time>24 hours) and low risk (not having any risk factors, comprising approximately 15% of the cohort). Following the elimination of dominated options, we estimated expected ICER among induction categories: no-induction, alemtuzumab, rabbit anti-thymocyte globulin (r-ATG), and interleukin-2 receptor-antagonist. No-induction was the least effective and most costly option in both risk groups. Depletional antibodies (r-ATG and alemtuzumab) were more cost-effective across all willingness-to-pay thresholds in the low-risk group. For the high-risk group and its subcategories, the ICER was very sensitive to the graft survival; overall both depletional antibodies were more cost-effective, mainly for higher willingness to pay threshold ($100,000 and $150,000). r-ATG appears to achieve excellent cost-effectiveness acceptability curves (%80 of the recipients) in both risk groups at $50,000 threshold (except age>60 years). In addition, only r-ATG was associated with graft survival benefit over no-induction category (hazard ratio 0.91, 95% confidence interval 0.84 to 0.99) in a multivariable Cox regression analysis. Antibody-based induction appears to offer substantial advantages in both cost and outcome compared to no-induction. Overall, depletional induction (preferably r-ATG) appears to offer the greatest benefits.
