Cost-Effectiveness of Belatacept as Conversion Therapy in the Management of Patients Living With a Renal Graft in France
Author(s)
Pierrick Arnal, PhD1, Melanie Chartier, MSc2, Caroline Guilmet3, Elise Cabout, MSc4, Radu Vadanici, MD5, FRANCOIS-EMERY COTTE, MA, MPH, PharmD, PhD6, Jerome Fernandes, PH7, Alexandre Loupy8.
1Paris Translational Research Centre for Organ Transplantation, Paris, France, 2HEOR Manager, Bristol Myers Squibb, Rueil Malmaison, France, 3BMS, Reuil-Malmaison, France, 4steve consultants, Artigues-près-Bordeaux, France, 5Bristol Myers Squibb, Rueil-Malmaison, France, 6Bristol Myers Squibb, RUEIL MALMAISON, France, 7CH de la cote Basque, BAYONNE CEDEX, France, 8Necker hospital, France.
1Paris Translational Research Centre for Organ Transplantation, Paris, France, 2HEOR Manager, Bristol Myers Squibb, Rueil Malmaison, France, 3BMS, Reuil-Malmaison, France, 4steve consultants, Artigues-près-Bordeaux, France, 5Bristol Myers Squibb, Rueil-Malmaison, France, 6Bristol Myers Squibb, RUEIL MALMAISON, France, 7CH de la cote Basque, BAYONNE CEDEX, France, 8Necker hospital, France.
OBJECTIVES: The challenge in kidney transplantation (KT) management is to sustain graft functionality via effective immunosuppressive therapies. Tacrolimus, a common calcineurin inhibitor (CNI), is standard but can cause nephrotoxicity and impact graft survival. Approved in France since 2021, belatacept offers an alternative conversion therapy to prevent KT rejection. A French real-world study of 311 KT patients (2007- 2020) demonstrated that converting to belatacept reduce the risk of graft loss (GL) with acceptable safety compared to ongoing CNI use. This analysis evaluates the cost-effectiveness of belatacept as conversion therapy in French healthcare setting.
METHODS: A 7-states Markov model, adapted from the NICE-validated PENTAG model, compared belatacept and tacrolimus as maintenance therapies for KT patients, from the French healthcare system perspective. Health states included functioning graft (FG), GL and death with up to 2 re-transplantations possible. Transition probabilities were based on French real-world data and the French Biomedicine Agency database. Hospital costs were calculated using 2025 French DRG tariffs, and utilities were sourced from literature. The base-case analysis simulated a cohort of 1,000 patients over a 15-year time horizon, applying a 2.5% annual discount rate.
RESULTS: Over a 15-years, belatacept generate costs saving of €24,921 per patient (€279,177 vs €304,097) and gained 0.47 QALY (8.93 vs. 8.49) compared to tacrolimus, resulting in a dominant incremental cost-utility ratio. Increased acquisition and administration costs (+€44,314 ,+53%), were offset by significant savings in dialysis costs, constituting 78% of total savings (€55,406). For 1,000 patients, belatacept could prevent 104 re-transplants, 157 GL and 40 deaths compared to tacrolimus.
CONCLUSIONS: Belatacept as conversion therapy for KT rejection prophylaxis is a dominant strategy in the French healthcare context, delivering both cost savings and improved patient outcomes compared to tacrolimus. Delaying graft loss reduces dialysis dependency and postpones re-transplantation, enhancing patient health and economic burden.
METHODS: A 7-states Markov model, adapted from the NICE-validated PENTAG model, compared belatacept and tacrolimus as maintenance therapies for KT patients, from the French healthcare system perspective. Health states included functioning graft (FG), GL and death with up to 2 re-transplantations possible. Transition probabilities were based on French real-world data and the French Biomedicine Agency database. Hospital costs were calculated using 2025 French DRG tariffs, and utilities were sourced from literature. The base-case analysis simulated a cohort of 1,000 patients over a 15-year time horizon, applying a 2.5% annual discount rate.
RESULTS: Over a 15-years, belatacept generate costs saving of €24,921 per patient (€279,177 vs €304,097) and gained 0.47 QALY (8.93 vs. 8.49) compared to tacrolimus, resulting in a dominant incremental cost-utility ratio. Increased acquisition and administration costs (+€44,314 ,+53%), were offset by significant savings in dialysis costs, constituting 78% of total savings (€55,406). For 1,000 patients, belatacept could prevent 104 re-transplants, 157 GL and 40 deaths compared to tacrolimus.
CONCLUSIONS: Belatacept as conversion therapy for KT rejection prophylaxis is a dominant strategy in the French healthcare context, delivering both cost savings and improved patient outcomes compared to tacrolimus. Delaying graft loss reduces dialysis dependency and postpones re-transplantation, enhancing patient health and economic burden.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE168
Topic
Economic Evaluation
Disease
Urinary/Kidney Disorders