An economic and quality-of-life assessment of basiliximab vs antithymocyteglobulin immunoprophylaxis in renal transplantation

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 a dvantages over other induction therapies has not vet 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 tw o induction therapy regimens: basiliximab and antithymocyte globulin (ATG) as part of a quadruple immunosuppressive regimen, Medical resources used an d a EuroQol visual analogue scale (VAS) rating of quality of life were coll ected prospectively for the 135 dosed subjects for a period of 1 year post- treatment. We analysed the differences between treatment groups in 1-year c osts and 1-year quality-adjusted survival. We also conducted a post hoc ana lysis of outcomes among the subgroup of patients identified as high risk. Results. A significant difference was observed in first-year post-treatment costs (basiliximab, $45 857; ATG, $54 729; difference, $8 872 (95% CI, $11 69 to $16 573), The savings from basiliximab call 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 hospita lization totalling $2609. One-year quality-adjusted survival was the same i n 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 patient s were comparable to the analysis of all patients. Conclusions. These results demonstrate lower first-year post-treatment cost s in renal-transplant recipients receiving basiliximab compared to ATG with no differences in quality-adjusted survival. The results also suggest simi lar differences among high-risk subjects.