Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss
Abstract Background: A new induction therapy strategy of a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG) showed a lower incidence of acute rejection. Methods: The objective of this study was to use real-world data to determine the incremental cost-effectiveness ratio (ICER) of r-ATG...
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| Format: | Article |
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Sociedade Brasileira de Nefrologia
2024-12-01
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| Series: | Brazilian Journal of Nephrology |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002025000100304&lng=en&tlng=en |
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| author | Adrieli Barros Bessa Marina Pontello Cristelli Claudia Rosso Felipe Renato Demarchi Foresto Marcelo Cunio Machado Fonseca Jose Medina Pestana Helio Tedesco-Silva |
| author_facet | Adrieli Barros Bessa Marina Pontello Cristelli Claudia Rosso Felipe Renato Demarchi Foresto Marcelo Cunio Machado Fonseca Jose Medina Pestana Helio Tedesco-Silva |
| author_sort | Adrieli Barros Bessa |
| collection | DOAJ |
| description | Abstract Background: A new induction therapy strategy of a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG) showed a lower incidence of acute rejection. Methods: The objective of this study was to use real-world data to determine the incremental cost-effectiveness ratio (ICER) of r-ATG induction for the prevention of acute rejection (AR) in the first year following kidney transplantation and for kidney graft survival over 1, 4, and 10 years of post-transplantation from the perspective of the national public healthcare system. A Markov state transition model was developed utilizing real-world data extracted from medical invoices from a single center. The study population consisted of adults at low immunological risk undergoing their initial transplantation and received kidneys from either living or deceased donors. The intervention of r-ATG induction was compared to no induction. The clinical outcomes considered for this analysis were acute rejection, cytomegalovirus infection/disease, death, graft loss, and retransplantation. Results: The cost-effectiveness analysis in the first year revealed that the r-ATG group was more cost-effective, with an ICER of US$ 399.96 per avoided AR episode, an effectiveness gain of 0.01 year in graft survival and a total incremental cost of US$ 147.50. The 4- and 10-year analyses revealed an effectiveness gain of 0.06 and 0.16 years in graft survival in the r-ATG induction group, and a total incremental cost of US$ −321.68 and US$ −2,440.62, respectively. Conclusion: The single 3 mg/kg dose of r-ATG is cost-effective in preventing acute rejection episodes and dominant in the long term of transplantation, conferring survival gain. |
| format | Article |
| id | doaj-art-cdb5c2b1a89542e6a650cfbb9bc93eea |
| institution | Kabale University |
| issn | 2175-8239 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Sociedade Brasileira de Nefrologia |
| record_format | Article |
| series | Brazilian Journal of Nephrology |
| spelling | doaj-art-cdb5c2b1a89542e6a650cfbb9bc93eea2025-01-07T07:40:06ZengSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology2175-82392024-12-0147110.1590/2175-8239-jbn-2024-0060enReal-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft lossAdrieli Barros Bessahttps://orcid.org/0000-0001-6987-2016Marina Pontello Cristellihttps://orcid.org/0000-0002-2813-0400Claudia Rosso Felipehttps://orcid.org/0000-0002-8597-4466Renato Demarchi Forestohttps://orcid.org/0000-0001-9370-0265Marcelo Cunio Machado Fonsecahttps://orcid.org/0000-0003-0803-3715Jose Medina Pestanahttps://orcid.org/0000-0002-0750-7360Helio Tedesco-Silvahttps://orcid.org/0000-0002-9896-323XAbstract Background: A new induction therapy strategy of a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG) showed a lower incidence of acute rejection. Methods: The objective of this study was to use real-world data to determine the incremental cost-effectiveness ratio (ICER) of r-ATG induction for the prevention of acute rejection (AR) in the first year following kidney transplantation and for kidney graft survival over 1, 4, and 10 years of post-transplantation from the perspective of the national public healthcare system. A Markov state transition model was developed utilizing real-world data extracted from medical invoices from a single center. The study population consisted of adults at low immunological risk undergoing their initial transplantation and received kidneys from either living or deceased donors. The intervention of r-ATG induction was compared to no induction. The clinical outcomes considered for this analysis were acute rejection, cytomegalovirus infection/disease, death, graft loss, and retransplantation. Results: The cost-effectiveness analysis in the first year revealed that the r-ATG group was more cost-effective, with an ICER of US$ 399.96 per avoided AR episode, an effectiveness gain of 0.01 year in graft survival and a total incremental cost of US$ 147.50. The 4- and 10-year analyses revealed an effectiveness gain of 0.06 and 0.16 years in graft survival in the r-ATG induction group, and a total incremental cost of US$ −321.68 and US$ −2,440.62, respectively. Conclusion: The single 3 mg/kg dose of r-ATG is cost-effective in preventing acute rejection episodes and dominant in the long term of transplantation, conferring survival gain.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002025000100304&lng=en&tlng=enCost-effectivenessReal-worldRabbit Antithymocyte GlobulinKidney Transplantation |
| spellingShingle | Adrieli Barros Bessa Marina Pontello Cristelli Claudia Rosso Felipe Renato Demarchi Foresto Marcelo Cunio Machado Fonseca Jose Medina Pestana Helio Tedesco-Silva Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss Brazilian Journal of Nephrology Cost-effectiveness Real-world Rabbit Antithymocyte Globulin Kidney Transplantation |
| title | Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss |
| title_full | Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss |
| title_fullStr | Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss |
| title_full_unstemmed | Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss |
| title_short | Real-world cost-effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss |
| title_sort | real world cost effectiveness analysis of thymoglobulin versus no induction therapy in kidney transplant recipients at low risk of graft loss |
| topic | Cost-effectiveness Real-world Rabbit Antithymocyte Globulin Kidney Transplantation |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002025000100304&lng=en&tlng=en |
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