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The Pharmacoeconomics of Renal Transplantation: Increased Drug Costs with Decreased Hospitalization Costs
Author(s) -
Canafax Daniel M.,
Gruber Scott A.,
Chan Gary L.C.,
Miles Carol J.,
Matas Arthur J.,
Najarian John S.,
Cipolle Robert J.
Publication year - 1990
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1990.tb02576.x
Subject(s) - medicine , azathioprine , prednisone , creatinine , transplantation , immunosuppression , gastroenterology , immunosuppressive drug , surgery , disease
We evaluated the economic and clinical effects of two immunosuppressive drug regimens used to treat recipients of human leukocyte antigen (HLA)‐identical sibling donor renal transplants during the first posttransplant year. We compared consecutive patients in two groups of 30 who were given either antilymphoblast globulin (ALG), azathioprine, plus prednisone or cyclosporine, azathioprine, and prednisone for immunosuppression. We standardized all dollar values, costs and charges, to the 1986 level using our hospital's health care charge inflation rate. There were no significant differences between the two treatment groups for actual patient (100% vs 93%; p = 0.51) and graft survival rates (100% vs 93%; p = 0.51), average serum creatinine level (1.0 ± 0.3 vs 1.0 ± 0.2 mg%; p = 0.46), and most recent creatinine level (1.4 ± 0.3 vs 1.4 ± 0.7 mg%; p = 0.45). The average cyclosporine‐azathioprine‐prednisone costs were $3987/patient more for the first year of therapy than for ALG‐azathioprine‐prednisone. However, the former regimen produced an average of $9543/patient less in total hospitalization charges. This was due to both a shorter initial hospital stay and a decreased rate of rehospitalization, with a lower frequency of acute rejection episodes (p = 0.001) and infectious complications (p = 0.05). We conclude that, although this cyclosporine‐containing protocol was associated with increased drug costs, it is justified by decreased hospitalization charges that resulted from improved efficacy and safety.