A call for transplant stewardship: The need for expanded evidence-based evaluation of induction and biologic-based cost-saving strategies in kidney transplantation and beyond.

Autor: Jorgenson MR; Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, USA., Descourouez JL; Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, WI, USA., Brady BL; Department of Pharmacy, Indiana University Health University Hospital, Indianapolis, IN, USA., Chandran MM; Department of Pharmacy, Children's Hospital of Colorado, Aurora, CO, USA., Do V; Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA., Kim M; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA., Laub MR; Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA., Lichvar A; Department of Pharmacy Practice and Surgery, University of Illinois at Chicago, Chicago, IL, USA., Park JM; Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA., Szczepanik A; Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA., Alloway RR; Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2021 Sep; Vol. 35 (9), pp. e14372. Date of Electronic Publication: 2021 Jun 08.
DOI: 10.1111/ctr.14372
Abstrakt: Rising expenditures threaten healthcare sustainability. While transplant programs are typically considered profitable, transplant medications are expensive and frequently targeted for cost savings. This review aims to summarize available literature supporting cost-containment strategies used in solid organ transplant. Despite widespread use of these tactics, we found the available evidence to be fairly low quality. Strategies mainly focus on induction, particularly rabbit antithymocyte globulin (rATG), given its significant cost and the lack of consensus surrounding dosing. While there is higher-quality evidence for high single-dose rATG, and dose-rounding protocols to reduce waste are likely low risk, more aggressive strategies, such as dosing rATG by CD3+ target-attainment or on ideal-body-weight, have less robust support and did not always attain similar efficacy outcomes. Extrapolation of induction dosing strategies to rejection treatment is not supported by any currently available literature. Cost-saving strategies for supportive therapies, such as IVIG and rituximab also have minimal literature support. Deferral of high-cost agents to the outpatient arena is associated with minimal risk and increases reimbursement, although may increase complexity and cost-burden for patients and infusion centers. The available evidence highlights the need for evaluation of unique patient-specific clinical scenarios and optimization of therapies, rather than simple blanket application of cost-saving initiatives in the transplant population.
(© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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