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Dennis Xuan Guodong Chen Changxi Wang XingXing Yao Hongjun Yin Lei Zhang Jianwei Xuan Lizhong Chen 《Clinical therapeutics》2018,40(10):1741-1751
Purpose
Induction immunosuppression therapy is used to support optimal outcomes in kidney transplantation. This study was to assess the cost-effectiveness of rabbit antithymocyte globulin (r-ATG) versus ATG-Fresenius (ATG-F) in kidney transplantation in the Chinese setting from the perspective of the health care payer.Methods
A 2-part survival model was developed, consisting of a short-term part and a long-term part. The short-term part analyzed the first year, using the decision tree, and consisted of the functioning transplant, acute rejection (AR), delayed graft function (DGF), dialysis, and death health states. The long-term part analyzed 2 to 5 years, using Markov model, and consisted of the functioning transplant, chronic dysfunction, recurring primary disease, dialysis, and death health states, with capture of the association between DGF and graft loss. Costs, including drug acquisition and other direct medical costs, were derived from China IQVIA database (formerly known as IMS) hospitaldatabase, chart review, and physician interviews. Clinical outcomes and utility were retrieved from published literature. The model calculated quality-adjusted life-years (QALYs) and total costs per patient. Costs and QALYs were discounted at an annual rate of 3.5%. Univariate sensitivity analysis and probability sensitivity analysis (PSA) were conducted to assess the impact of uncertainty of the variables on the results.Findings
Patients who received r-ATG had more clinical effectiveness than patients who received ATG-F mainly because of less AR, DGF, and dialysis. The incremental QALY was 0.01 over a 1-year time horizon and 0.0496 over a 5-year time horizon. R-ATG and ATG-F drug costs were ¥10,783 and ¥8409, respectively. However, the total treatment costs of the r-ATG arm were lower than the ATG-F arm because of lower costs related to DGF, AR, dialysis, and adverse events. In total, r-ATG saved ¥5423 over the 1-year and ¥7042 over the 5-year time horizon. R-ATG was dominant with lower total direct medical costs and higher QALYs compared with ATG-F. Both univariate sensitivity analysis and PSA found the robustness of the model results. PSA results indicated that r-ATG was cost-effective compared with ATG-F in 86.81% of the simulations, considering <3 times the gross domestic product per capita as the threshold.Implications
From the perspective of the health care payer, r-ATG should be considered as the preferred treatment agent for induction therapy for Chinese patients undergoing kidney transplantation because of its lower overall medical costs and greater QALYs gained compared with ATG-F. The study was limited by lack of long-term efficacy data among the Chinese population and lack of comprehensive real-world higher quality costs data. 相似文献2.
目的探讨DCD捐献肾脏移植的经验及免疫诱导的临床效果观察。方法分析本院于2011年12月至2013年12月完成的40例DCD捐献肾移植患者的临床资料,根据免疫诱导药物的不同,分为舒莱组(10例)、ATG组(15例)和ATG-F组(15例)。结果 40例患者中除3例出现DGF外,其余患者术后血肌酐均平稳下降,恢复正常;3组患者中均有1例发生DGF,ATG组发生急排1例,其余组无急排发生;所有组均无原发肾无功能发生;CMV发生率:舒莱组4例(40%),ATG组10例(71%),ATG-F组11例(73%);ATG组发生肺部感染1例,其余组均无肺炎发生;ATG、ATG-F组分别有5、6例出现血小板及血红蛋白下降,无其他不良反应;除ATG组肺炎患者死亡外,其余均带功存活;术后恢复正常的肾脏病理表现为肾小球及肾小管结构清晰,而DGF的活检病理表现为肾小管肿胀,部分肾小管变性坏死。结论 DCD是解决我国器官移植界瓶颈的重要手段,中国三类(DBCD)是较理想的DCD供者。免疫诱导能够有效预防急性排斥的发生,但可引起机体广泛抑制,导致潜伏的CMV复活;取肾过程中尽量缩短热缺血时间,DGF发生率较低。供肾零点活检应该成为DCD供肾肾脏移植的常规检查项目,但慎重决定取舍。 相似文献
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Comparison of daclizumab,an interleukin 2 receptor antibody,to anti-thymocyte globulin-Fresenius induction therapy in kidney transplantation 总被引：2，自引：0，他引：2
The efficacy and safety of daclizumab and anti-thymocyte globulin-Fresenius (ATG-F) as induction therapy in kidney transplantation (KT) were investigated in 45 KT performed in our center between March and May 2002. Group II (n=10) received daclizumab as induction therapy, and Group I (n=35) were induced with a single intraoperative bolus therapy of ATG-F. All patients were at low-risk, and the recipient and donor demographics, as well the immunosuppression regimen employed were comparable in both groups. Drug safety, assessed by the occurrence of side effects, was almost comparable in the two groups, except for more thrombocytopenia in Group II (P<0.0004). Acute rejection (AR) occurred in 10% in Group I and 11.4% in Group II (P=NS). There were more infections in Group II (42.8%) than in Group I (10%) (P<0.009). Bacterial and viral infections were more common in Group II (69 and 23%) than in Group I (10 and 0%) (P<0.05). The hospital stay was similar in both groups. Mean serum creatinine levels upon discharge, at 1, 3 and 6 months were: 1.23+/-0.11, 1.21+/-0.06, 1.25+/-0.11 and 1.35+/-0.08 in Group I and 2.18+/-0.43, 1.49+/-0.16, 1.49+/-0.16 and 1.35+/-0.08 in Group II, respectively. While better serum creatinine levels were observed in Group I upon discharge (P<0.048), this was due to the presence of more sensitized patients in Group II. The 6 months actuarial patient and graft survival were identical in both groups (100 and 100%, respectively). Although both daclizumab and ATG-F were effective and safe as induction therapy in KT, less bacterial and viral infections and lower early serum creatinine levels were noted in daclizumab-treated patients. 相似文献
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目的 探讨抗人T-细胞兔免疫球蛋白(ATG-F)联合环孢菌素A(CSA)治疗儿童再生障碍性贫血的临床疗效及影响因素.方法 选取儿童再生障碍性贫血者40例,其中重型再障(SAA)22例,极重型再障(VSAA)8例,依赖输血型非重型再障(NSAA)10例.采用ATG-F联合环孢菌素A的免疫抑制疗法.观察治疗前后T细胞亚群、疗效和影响因素.结果 治疗后CD3+和CD4+的细胞比例显著升高,CD8+细胞比例显著下降,CD4+/ CD8+比值显著升高,差异有统计学意义(P<0.05);随访1年后发现,患儿的总有效率为72.5%(SAA+VSAA组为70.0%、NSAA组为80.0%),总生存率为85.0%,且SAA+VSAA组和NSAA组的各项疗效比较差异无统计学意义(P>0.05);疾病严重程度、性别、年龄与疗效无相关性,病程和淋巴细胞绝对计数下降幅度与疗效有相关性(P<0.05).病程≤6个月的患儿治疗有效率显著高于病程>6个月者(P<0.05),淋巴细胞绝对计数下降幅度>2×109·L-1的患儿有效率显著高于≤2×109·L-1者(P<0.05).结论 ATG-F与CSA联合使用治疗儿童再生障碍性贫血可改善T细胞功能异常,提高疗效,且早期治疗效果更优,同时提示两组药物联合使用时需对药物剂量进行个体化研究,保证免疫抑制疗效. 相似文献
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《Expert opinion on biological therapy》2013,13(9):1299-1313
Introduction: Two rabbit anti-thymocyte globulins (ATGs) (Thymoglobulin? and ATG-Fresenius (ATG-F)?) have been used commonly for induction immunosuppression and treatment of acute rejection in solid organ transplantation. Therefore, literature review on comparative efficacy and side-effect profile of them would be of clinical interest. Areas covered: This review evaluated all comparative studies in English language, focusing on the solid organ transplant patients who received Thymoglobulin or ATG-F as induction therapy. This review concluded that compared to ATG-F, Thymoglobulin possibly provides better protection against acute rejection and improves patient and graft survival but may result in more cytomegalovirus infection and post-transplant malignancy. Thymoglobulin produced more leukocyte depletion with a greater delay to recover, while ATG-F had more reduction effects on platelet and erythrocyte counts with an increased need to erythropoiesis-stimulating agent. Expert opinion: The benefits of induction therapy with ATGs must be weighed against the costs and post-transplant complications. It is suggest that there is no substantial clinical difference between these two rabbit ATGs and each may be considered as induction therapy for solid organ transplantation based on availability and drug cost. Of special importance is adding antiviral therapy to the treatment regimen of patients who receive ATGs as induction therapy. 相似文献
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