OBJECTIVES

To Analyze the cost-effectiveness of treatment regimens containing calcineurin inhibitors (CNI) plus antiproliferative agents in Brazilian Public Health System (SUS).

METHODS

We conducted cost effectiveness analysis using data from a national cohort study conducted from January 2000 to December 2015 with patients undergoing kidney transplantation (living or deceased donors) who used CNI (considered high-cost drugs) in all SUS transplant centers in Brazil. Propensity score matching analysis was established. The economic analysis was from public-payer perspective.

Markov model with focus on 15-year cost effectiveness analysis to compare the use of cyclosporine plus azathioprine versus cyclosporine plus mycophenolate, tacrolimus plus azathioprine and tacrolimus plus mycophenolate regimens in preventing graft loss in kidney transplantation. Survival by follow-up year and costs were calculated directly from the historical cohort. Monetary values were adjusted using the purchasing power parity (PPP) conversion factor of the World Bank. The model was used to estimate clinical benefits in life-years gained (LYG) with a functioning graft and the costs of alternative drugs in the follow-up period.

RESULTS

We identified 2,318 patients , 1,159 pairs were combined. Most patients were male; with median age was 43 years. In fifteen years, tacrolimus plus mycophenolate resulted in average life expectancy of 8.53 LYG, tacrolimus plus azathioprine in 8.82 LYG and cyclosporine plus mycophenolate in 8.09 LYG compared with 9.37 LYG in case of cyclosporine plus azathioprine The annual cost of treatment was US$ 75,130.557 with tacrolimus plus mycophenolate, US$ 65,557.24 tracolimus plus azathioprine, US$ 54,178.78 cyclosporine plus mycophenolate and US$ 42,962.93 with cyclosporine plus azathioprine.

CONCLUSIONS

Acording to the model, we observed that regimen with cyclosporine plus azathioprine was more effective and less costly than other regimens. The economic results may be useful for price regulation, both with regard to new drug price policies and to annual increases granted to the manufacturer.