Economic analysis of an immunosuppressive strategy in renal transplantation.

Recently introduced immunosuppressants, which have been shown to be more effective but apparently more costly than conventional regimens, have renewed interest in the economic evaluation of national policies regarding the management of end-stage renal disease. The present paper addresses these questions, together with the different methods of expressing the costs involved, with reference to a sequential protocol using anti-lymphocyte serum (ALS), followed by cyclosporine from the third post-graft month onwards. The analysis is based on the results of a randomized trial carried out at the University Hospital, Nantes (France), from 1982 to 1984, in which the above protocol was compared to conventional treatment with ALS alone. Despite the considerable cost of long-term cyclosporine treatment, analysis reveals collective financial and social benefits from the reduced rate of graft failure and subsequent return to dialysis.