An economic and quality‐of‐life assessment of basiliximab vs antithymocyte globulin immunoprophylaxis in renal transplantation

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Abstract
Background. Immunosuppressive therapy with cyclosporin A has substantially improved clinical outcomes for renal transplantation. Whether basiliximab (a chimeric monoclonal antibody) demonstrates economic and quality‐of‐life advantages over other induction therapies has not yet been shown. Methods. A multi‐centre open‐label clinical trial was conducted among renal transplant recipients in the US, in which patients were randomized into two induction therapy regimens: basiliximab and antithymocyte globulin (ATG) as part of a quadruple immunosuppressive regimen. Medical resources used and a EuroQol visual analogue scale (VAS) rating of quality of life were collected prospectively for the 135 dosed subjects for a period of 1 year post‐treatment. We analysed the differences between treatment groups in 1‐year costs and 1‐year quality‐adjusted survival. We also conducted a post hoc analysis of outcomes among the subgroup of patients identified as high risk. Results. A significant difference was observed in first‐year post‐treatment costs (basiliximab, $45857; ATG, $54729; difference, $8872 (95% CI, $1169 to $16573). The savings from basiliximab can be attributed to the less expensive induction therapy (basiliximab, $2378; ATG, $8670; difference, $6292 (95% CI, $5165 to $7419)) and other savings during the initial hospitalization totalling $2609. One‐year quality‐adjusted survival was the same in both groups (basiliximab, 81.5; ATG, 81.1; difference, 0.45 (95% CI, −5.9 to 6.8)). The results of the post hoc analysis of the 48 high‐risk patients were comparable to the analysis of all patients. Conclusions. These results demonstrate lower first‐year post‐treatment costs in renal‐transplant recipients receiving basiliximab compared to ATG with no differences in quality‐adjusted survival. The results also suggest similar differences among high‐risk subjects.

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