A PHARMACOECONOMIC COMPARISON OF ANTITHYMOCYTE GLOBULIN AND MUROMONABCD3 INDUCTION THERAPY IN RENAL-TRANSPLANT RECIPIENTS

Antithymocyte globulin (ATG) and muromonab CD3 (OKT3) are currently th e only antilymphocyte preparations that are commercially available for induction immunosuppressive therapy for renal allograft transplantati on in the US. ATG, in the usually prescribed doses, is more expensive than muromonab CD3, but muromonab CD3 is associated with more severe a dverse effects that may affect clinical outcome and overall cost. We p erformed a retrospective study of all adult recipients of a first cada veric renal allograft, who underwent transplantation between January 1 991 and December 1994 who received either ATG (n = 92) or muromonab CD 3 (n = 91)for induction therapy at our transplant centre. The average age of recipients was older (50 vs 44 yrs; p = 0.001) and extended don ors were more commonly used in the ATG group (41 vs 13%, p = 0.0001) c ompared with the muromonab CD3 group. Nevertheless, at 1 year post-tra nsplant, the incidence of rejection was lower (34 vs 47%) and graft su rvival was better (93 vs 85%; p = 0.03) in the ATG group. Patients who received ATG were discharged earlier (9.4 vs 13.3 days, p = 0.0001) a nd had similar serum creatinine levels on the day of discharge (2.4 +/ - 1.5 vs 2.1 +/- 1.1 mg/dl; p = 0.25). Overall the 1-year hospitalisat ion costs of transplantation and readmissions were Similar [$US39 937 +/- 17 014 vs $US42 850 +/- 20 923 (currency year 1994); p = 0.22]. Th is is the first comparison of ATG and muromonab CD3 in renal transplan t recipients to consider clinical as well as economic outcomes. For re nal transplant patients in whom induction therapy is used at our centr e, the initial expense of ATG can be justified by improved graft survi val, fewer rejection episodes, and shorter hospital stays, which are a ssociated with similar overall transplantation costs.