Pharmacoeconomic evaluation of simulect prophylaxis in renal transplant recipients

Advances in immunosuppressive therapy have substantially improved one-year clinical outcomes for renal transplantation.1 However, acute rejection still occurs in up to 50% of kidney transplantation recipients during the first year,2 and it remains the major contributor to chronic rejection and long-term graft failure. [3], [4] and [5] Although episodes of acute rejection are reversible with heightened doses of steroids and antibody therapy, the implications for increased healthcare costs and poor long-term outcome underscore the importance of developing therapies to reduce acute rejection. Basiliximab (Simulect, Novartis, Basel, Switzerland) is a high-affinity chimeric antiinterleukin-2 receptor monoclonal antibody that is indicated for the prophylaxis of acute rejection after renal transplantation. [6] and [7] Randomised clinical trials have demonstrated that basiliximab is highly effective in suppressing acute rejection when used in combination with dual therapy of cyclosporin and steroids. [8] and [9] Recently, a phase III international multi-centre trial was performed to evaluate the effectiveness of basiliximab in renal transplantation patients receiving a standard triple therapy regimen of cyclosporin, steroids, and azathioprine.10 An economic evaluation of the trial was undertaken alongside the clinical studies. We determined the economic impact of adding basiliximab to triple therapy. Our objectives were to compare within-trial resource use between basiliximab-treated and placebo-treated patients within six months of renal transplantation and to evaluate the cost implications of basiliximab use, relative to clinical outcomes.