Lack of economic benefit with basiliximab induction in living related donor adult renal transplant recipients

Study Objective. To assess the effect of basiliximab (BAS) induction therapy on acute rejection rates and overall costs in adult living related donor (LRD) renal transplant recipients. Design. Retrospective chart review and cost-effectiveness analysis of the first 12 months after transplantation. Setting. University hospital and outpatient renal transplant clinic. Patients. Sixty consecutive adult LRD renal transplant recipients. Intervention. The treatment group received BAS 20 mg intravenously on postoperative days 0 and 4. The control group received no induction agents. Both groups received cyclosporine microemulsion, azathioprine, and corticosteroids for maintenance immunosuppression. Measurements and Main Results. Six patients (three in each group) were excluded; three had received muromonab-CD3 as an induction agent and three were lost to follow-up. At 12-months, the frequency of acute rejection episodes was 15% (4/27) in the control group and 22% (6/27) in the BAS group (NS). Renal function, as measured by average serum creatinine level, was similar at months 1, 2, 3, 6, and 12 for both groups. The frequency of infectious complications was similar in both groups. No adverse effects were associated with BAS. Mean initial hospitalization charges were $51,970.01 and $68,093.90 in the control and BAS groups, respectively (p<0.05). The control group had more readmissions (18 vs 14 in the BAS group), but the average charge/readmission was lower ($10,148.50 vs $21,952.58 in the BAS group; NS). All costs were adjusted to 2000 dollars (US). Conclusion. Basiliximab induction therapy did not provide clear clinical efficacy benefit or prove to be cost-effective compared with no induction in LRD recipients.