Assessment of alternative technologies for the treatment of end-stage renal disease.

A general approach to the assessment of emerging medical technologies is illustrated by means of an analysis of the medical and fiscal impacts of the adoption of cyclosporin for immunosuppression in renal transplantation. The medical impacts evaluated include the effect on graft failure and patient mortality rates, on the incidence of rejection and other posttransplant complications, and on the level of functional rehabilitation achieved. The fiscal impacts examined include the effects on the cost of managing transplant recipients as well as of dialysis, because almost all renal transplanted patients were initially maintained on dialysis, and most graft failures result in return to chronic dialysis. Cyclosporin--despite being a very expensive drug--reduces the rate of cadaver-donor graft failure without increasing the overall costs of managing the recipients in the first 6 months post transplant. If cyclosporin can be discontinued within 3 years of transplantation, the medical benefits can be realized without added expenditures, principally because of the savings accrued due to a reduced need for maintenance dialysis.