The association of cyclosporine with the 1-year costs of cadaver-donor kidney transplants

Article Abstract:

Cyclosporine, which suppresses the immune system, improves the survival of patients with transplanted kidneys. Since this agent may cause toxicity, its clinical effect may diminish over time, and it is very expensive, questions have been raised about replacing cyclosporine with the immunosuppressant azathioprine several months after kidney transplantation. Following transplant surgery, it seems clear that cyclosporine reduces hospital costs, but whether the financial benefit continues beyond this period is unknown. The advisability of continuing to prescribe cyclosporine for transplant patients was evaluated by studying 203 patients who received cadaver kidneys during a four-year period at one medical center. Attempts were made to gather data from hospital billing records and Medicare. Following transplantation, cyclosporine was associated with 88.7 percent graft survival, compared with 71 percent graft survival for patients not treated with cyclosporine. One year after transplant surgery, the proportion of graft survival was the same in both groups. Patients who received cyclosporine had fewer post-transplant hospital days (26.4 days) than patients treated with other drugs (40.3 days). The average number and duration of re-admissions did not differ between cyclosporine- and noncyclosporine-treated groups. A statistically significant difference was noted between the adjusted total average annual costs of patients treated with cyclosporine ($37,174) and those who were not ($52,983). This difference was due primarily to fees charged during the initial hospitalization. Drug charges were higher for cyclosporine-treated patients, but their physician fees were lower. The results suggest that, while cyclosporine is cost-effective immediately after transplant surgery, it may become too expensive in the ensuing period, when all charges are taken into account. To better evaluate the clinical outcome of switching to a less expensive immunosuppressive agent, data describing patients who change from cyclosporine to azathioprine must be evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Graft rejection, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Cost (Economics), Costs (Economics)

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The effect of cyclosporine on the use of hospital resources for kidney transplantation

Article Abstract:

When an organ such as a kidney is removed from a cadaver or from a tissue-matched relative and transplanted into a recipient, there is always the possibility that the immune system of the recipient will reject it. The rejection is called graft-versus-host disease, and it results from the recipient's immune system detecting subtle differences in proteins of the donated organ that mark it as foreign, and then carrying out an immunologic attack to remove it. Much of the success of transplantation during the 1980s can be directly attributed to the introduction of cyclosporine, a drug that suppresses the immune response. The changes in the numbers of hospital stays, readmissions, and the costs of kidney transplantation before and after the advent of immunosuppressive therapy and current techniques utilizing cyclosporine were reviewed. The study involved the histories of 702 kidney transplant patients. The costs of treatment and hospitalization were normalized to 1985 dollars to account for economic differences. The introduction of cyclosporine decreased the average hospital stay for cadaver kidney transplantation from 37 days to 26.4 days and the cost of the procedure from $37,895 to $28,649. Other ancillary costs such as laboratory fees and disposable items were also found to decrease substantially as a result of cyclosporine treatment. However, there was no significant effect on cost when the kidney was transplanted from living donors. Most of the decrease in cost was after the procedure; as expected, there was little reduction in costs during preoperative and evaluatory phases of the procedure.

Drug therapy, Kidneys, Kidney transplantation, Immunosuppressive agents, Graft versus host reaction, Transplantation immunology, Graft vs. host disease

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Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education

Article Abstract:

A reorganization of an academic medical center to allow faculty members greater input in patient care may lower costs without sacrificing quality of care. Researchers at Moffitt-Long Hospital in San Francisco reorganized the four-team inpatient service into two managed care services (MCS) and two traditional services (TS). Faculty in the MCS served as attending physicians more often and provided input soon after patients were admitted. Approximately 800 patients were admitted to both services and the MCS resulted in lower costs without compromising quality of care or patient satisfaction.

Medical centers, Managed care plans (Medical care), Medical case management

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