Abstract: TH-PO167

Cost Analysis on the Use of Rituximab and Calcineurin Inhibitor in Children and Adolescents with Steroid Dependent Nephrotic Syndrome

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Bamgbola, Oluwatoyin F., SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Aviles, Diego H., Louisiana state university health science center, New Orleans, Louisiana, United States
  • Iorember, Franca M, Phoenix Children''s Hospital, Scottsdale, Arizona, United States
Background

To minimize adverse effects, steroid sparing agents are used in steroid dependent nephrotic syndrome (SDNS). Although effective, the main drawback of calcineurin inhibitors (CNI) is the need for therapeutic drug monitoring (TDM). Apart from proven efficacy, Rituximab produces a long lasting remission after 1 or 2 single intravenous doses. To reduce frequency of clinic visits and cost efficiency, we introduced rituximab particularly in patients living remotely from laboratory facilities.

Methods

A retrospective analysis of pediatric patients with SDNS treated with either CNI &/ or Rituximab from Jan 2008 to Dec 2012 at Children’s Hospital of New Orleans, Louisiana. All patients were followed up for a minimum of 12 months. We compared the cost effectiveness, efficacy, and safety profiles of the 2 groups.

Results

Ten patients were treated with Rituximab while 8 received CNI. Baseline data were comparable. Annual cost of treatment was lower with Rituximab ($197,031 vs. $189,856; p > 0.05). Amount expended on Rituximab arm was mostly due to drug cost and mandatory hospitalization for infusion. Due to frequent clinic visits for TDM, cost of outpatient care was more for the CNI ($4383 vs. $7534). There was marginally better control of SDNS with use of Rituximab. Duration of freedom from steroid was twice longer for those treated with Rituximab (p > 0.05). This accounted for twice the annual gain in body mass index in the CNI arm (1.5 kg/m2 vs. 0.8 kg/m2). There was no significant side effect in either group. Retrospective design & small sample size limited ability to demonstrate significant findings. In addition, study outcome may vary with regional differences in health care financial system. Nevertheless, we believe this is the first study of this kind in the pediatric population.

Conclusion

Although Rituximab is marginally more efficacious than CNI, short-term safety profiles are comparable. The annual cost of health care for patients on Rituximab is essentially similar to that of CNI. By cutting the need for frequent outpatient visits, Rituximab may curtail number of school absences, parental loss of wages, and the burden of health care on family. By minimizing the need for steroids and CNI, Rituximab use may avoid hypertension, dyslipidemia, short stature and impairment in renal function.