@article{43e4bfe68fb04f6db2ab9d8e8be0d829,
title = "Economic impacts of alternative kidney transplant immunosuppression: A national cohort study",
abstract = "Understanding the economic implications of induction and maintenance immunosuppression (ISx) is important in developing personalized kidney transplant (KTx) care. Using data from a novel integrated data set including financial records from the University Health System Consortium, Medicare, and pharmacy claims (2007-2014), we estimated the differences in the impact of induction and maintenance ISx regimens on transplant hospitalization costs and Medicare payments from KTx to 3 years. Use of thymoglobulin (TMG) significantly increased transplant hospitalization costs ($12 006; P =.02), compared with alemtuzumab and basiliximab. TMG resulted in lower Medicare payments in posttransplant years 1 (−$2058; P =.05) and 2 (−$1784; P =.048). Patients on steroid-sparing ISx incurred relatively lower total Medicare spending (−$10 880; P =.01) compared with patients on triple therapy (tacrolimus, antimetabolite, and steroids). MPA/AZA-sparing, mammalian target of rapamycin inhibitors-based, and cyclosporine-based maintenance ISx regimens were associated with significantly higher payments. Alternative ISx regimens were associated with different KTx hospitalization costs and longer-term payments. Future studies of clinical efficacy should also consider cost impacts to define the economic effectiveness of alternative ISx regimens.",
keywords = "economics, health expenditures, induction immunosuppression, kidney transplantation, maintenance immunosuppression, registries",
author = "Axelrod, {David A.} and Yasar Caliskan and Schnitzler, {Mark A.} and Huiling Xiao and Dharnidharka, {Vikas R.} and Segev, {Dorry L.} and Mara McAdams-DeMarco and Brennan, {Daniel C.} and Henry Randall and Tarek Alhamad and Kasiske, {Bertram L.} and Gregory Hess and Lentine, {Krista L.}",
note = "Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01-DK102981 and R01-DK120518. KLL receives support from the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, and ELS, for manuscript editing. Funding Information: This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government‐sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. This work was supported by grants from the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01‐DK102981 and R01‐DK120518. KLL receives support from the Mid‐America Transplant/Jane A. Beckman Endowed Chair in Transplantation. The opinions, results, and conclusions reported in this article are those of the authors and are independent of the funding sources. The authors thank SRTR colleague Nan Booth, MSW, MPH, and ELS, for manuscript editing. Publisher Copyright: {\textcopyright} 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",
year = "2020",
month = apr,
day = "1",
doi = "10.1111/ctr.13813",
language = "English (US)",
volume = "34",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley",
number = "4",
}