Cost-Savings Realized Using Rabbit Anti-Thymocyte Globulin Ideal Body Weight Dosing for Kidney Transplantation Induction Immunosuppression

Introduction Rabbit anti-thymocyte globulin (rATG) induction ideal dosing strategies in kidney transplant recipients have not been fully elucidated. Project Aims This study compares the impact of ideal body weight-based versus actual body weight-based rATG dosing on drug purchasing costs and kidney transplant outcomes. Design Retrospective, single-center chart review of kidney transplant recipients receiving rATG induction using (1) actual body weight-based dosing between May 17, 2019, and Mar 13, 2020, versus (2) ideal body weight-based dosing between May 17, 2022, and Mar 13, 2023. The primary endpoint is the rATG drug cost/kidney transplant recipient [measured by average wholesale price] compared between cohorts. Secondary endpoints are rates of biopsy-proven acute rejection, readmissions secondary to infection, myelosuppression (leukopenia or neutropenia), and viremia (Epstein-Barr virus, cytomegalovirus, and BK virus) measured for 6 months. Study design adhered to EQUATOR STROBE guidelines for reporting cohort studies. Results Overall, rATG ideal body weight-based dosing resulted in a median $3838 saved per kidney transplant recipients, based on average wholesale price, and a statistically significant reduction in cost versus actual body weight-based dosing ( P = .02). Secondary outcomes were generally similar between groups, with a difference in Epstein-Barr viremia ( P = .017) not translating to a significant difference in readmissions for infection ( P = .226). Conclusion Our institution conducts around 250 kidney transplants annually, and considering the majority will receive rATG induction, this dosing protocol estimates average wholesale price drug purchasing cost-savings of about $900 000/year without compromising early clinical outcomes.