Incidence and long-term cost of steroid-related side effects after renal transplantation

Corticosteroids are an essential component of most immunosuppressive regime ns currently used in renal transplantation because of their efficacy in red ucing acute rejection and improving graft survival, Steroids, however, are associated with numerous side effects that lead to increased patient morbid ity and mortality, The incidence and economic cost of steroid-related side effects have not been quantitatively assessed. Thus, based on a systematic review of the published literature, we estimated the incidence of steroid-r elated hypertension (15%), posttransplantation diabetes mellitus (10%), per ipheral fractures (2% per year), avascular necrosis of the hip (8%), and ca taracts (22%), In addition, we estimated that approximately 5% of patients who have cataracts or avascular necrosis of the hip require surgery. We use d these literature-based estimates in a model to project the costs of treat ing side effects over a 10-year posttransplantation time frame for a 50-pat ient cohort that represented an average-sized renal transplant center. Ster oid-induced hypertension and its complications were the most expensive side effect ($93,900), followed closely by posttransplantation diabetes ($89,70 0) and avascular necrosis of the hip ($61,700), Cataracts and peripheral bo ne fractures were less costly ($16,300 and $4,300, respectively). The cumul ative projected 10-year cost of all side effects for the 50-patient cohort was $265,900, or $5,300 per transplant patient. Steroid-related side effect s add to the long-term cost of medical care of renal transplant recipients, These costs provide a rationale for further investigation of steroid-spari ng immunosuppression protocols. (C) 1999 by the National Kidney Foundation, Inc.