Analysis of Cost Effectiveness of Treatment for Acute Antibody-Mediated Rejection
Tulane University School of Medicine, New Orleans, LA.
Meeting: 2018 American Transplant Congress
Abstract number: B300
Keywords: Economics, Graft failure, Kidney transplantation, Rejection
Session Information
Session Name: Poster Session B: Non-Organ Specific: Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Because AMR can be a risk factor for graft loss, the expense created by AMR treatment may be subject to scrutiny in patients who suffer from graft loss and return to dialysis despite treatment; therefore, an analysis was performed to determine the cost effectiveness of AMR treatment.
Methods: 64 patients with AMR (with or without cell-mediated rejection) were identified from a larger cohort of 868 patients who had undergone renal transplant between 2006-2016. Years of post-AMR treatment graft life were calculated. Wholesale drug costs for IVIG, rituximab, and bortezomib were obtained from our transplant pharmacist, and the percent markup for administrative costs/overhead was estimated by the pharmacy buyer to be about 300%. The cost of plasmapheresis (including hospital stay) was also obtained. The cost of AMR treatment for each patient was calculated. The annual cost of dialysis was also identified. This was used to calculate a theoretical dialysis cost for each year of graft survival afforded by AMR treatment. This value was divided by the actual cost of AMR treatment for each patient to determine the benefit-cost ratio. Calculations were conducted for both the total AMR cohort and those who experienced graft failure.
Results:
| AMR Cohort | Graft Failure | |
| Median Cost of AMR Tx | $ 48,309 | $49,699 |
| Max Cost of AMR Tx | $113,729 | $53,929 |
| Annual Dialysis Cost/Patient | $88,000 | $88,000 |
| Median Dialysis Cost Avoided | $ 387,682 | $46,652 |
| Median Years of Graft Survival | 4.41 | 0.87 |
| Median Benefit-Cost Ratio | +$6.59 | + $1.24 |
| Total Spent on AMR Tx | $2,662,691 | $322,763 |
| Total Saved on Dialysis | $22,357,786 | $612,624 |
For the overall cohort, the median benefit-cost ratio was $6.59, meaning that for every dollar spent on AMR treatment, $6.59 dialysis dollars were saved, and for the group that experienced graft loss, for every dollar spent on AMR treatment, $0.24 was saved on dialysis costs.
Conclusion:
It's clear that despite the existence of graft failure after AMR treatment in some patients, it is more cost effective to treat patients for AMR rather than have them return to dialysis, even if only months of graft life are saved.
CITATION INFORMATION: McDermott C., Carsky K., Ferrin P., Gaines A., Chernobylsky D., Killackey M., Paramesh A., Zhang R., Buell J. Analysis of Cost Effectiveness of Treatment for Acute Antibody-Mediated Rejection Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
McDermott C, Carsky K, Ferrin P, Gaines A, Chernobylsky D, Killackey M, Paramesh A, Zhang R, Buell J. Analysis of Cost Effectiveness of Treatment for Acute Antibody-Mediated Rejection [abstract]. https://atcmeetingabstracts.com/abstract/analysis-of-cost-effectiveness-of-treatment-for-acute-antibody-mediated-rejection/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress