Induction therapy is commonly used in kidney transplantation due to its ability to decrease the frequency of early acute rejection; it is associated with higher costs and potential toxicities leading to increased resource utilization. There is little information about comparisons between the various induction therapies, Interleukin 2 receptor antagonist (IL-2A), Alemtuzumab (Alem), and rabbit antithymocyte globulin (rATG). Alem is less expensive ($1700) than IL-2A ($3372) or rATG ($9960). Purpose: To examine resource utilization with Alem induction compared to other induction therapies, when used with a calcineurin inhibitor, mycophenolate and prednisone as maintenance therapy. Methods: This was a retrospective study that analyzed first year post transplant resource utilization from the transplant center perspective comparing patients that received Alem (n=30) for induction with 2 comparator groups that received either an IL-2A or rATG (n=60 for both groups). Subjects in the comparator groups were matched 2:1 for age and type of donor to subjects in Alem. Maintenance immunosuppression in all groups consisted of tacrolimus, mycophenolate, and prednisone. Granulocyte Colony Stimulating Factor (G-CSF) was given for an absolute neutrophil count < 500. Results: There were no differences in demographics between the 3 groups. Biopsy proven rejection occurred in 8% Alem, 13% IL-2A, and 2% r-ATG (p=.057). Use of G-CSF for neutropenia was significantly higher in Alem vs IL-2A or r-ATG (43%, 8%, 10%, p<.001); the cost of G-CSF therapy was significantly higher in Alem ($441) than in the other 2 groups (IL-2A $58, rATG $96)(p<.001). The number of additional lab tests compared to the routine post-transplant protocol was not significantly different between the 3 groups. The number of admissions to the hospital after the initial transplant hospitalization was not different between the 3 groups. However, the length of stays for hospital readmissions were longer in the Alem group (6.6 days) compared to IL-2A and rATG (both 2.77 days)(p=.05). The total costs for Alem ($25502) were significantly higher than for IL-2A ($8050) or the rATG group ($7630)(p=.008). Conclusion: Alem resulted in a significant increase in the utilization of G-CSF and had longer lengths of stay during readmissions to the hospital. Despite the smaller upfront cost, the Alem group had increased total costs during the first year post transplant when compared to the other 2 groups.

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