EVALUATING THE ECONOMIC IMPLICATIONS OF NONADHERENCE AND ANTIBODY-MEDIATED REJECTION IN RENAL TRANSPLANT RECIPIENTS- THE ROLE OF ONCE-DAILY, PROLONGED-RELEASE TACROLIMUS IN THE UK SETTING
Author(s)
Muduma G1, Odeyemi IA2, Pollock RF3
1Astellas Pharma Europe Ltd, Chertsey, UK, 2Astellas Pharma EMEA, Chertsey, UK, 3Ossian Health Economics and Communications GmbH, Basel, Switzerland
OBJECTIVES: While short-term kidney graft survival has gradually improved over time, improvements in long-term graft survival have been more modest. One key clinical factor limiting improved long-term outcomes is antibody-mediated rejection (AbMR). Recent data suggest that AbMR incidence is higher in non-adherent patients; a factor that can be improved by reducing pill burden. The aim of the present study was to model the incidence and economic consequences of graft loss and AbMR with once-daily, prolonged-release (PR) tacrolimus versus twice-daily, immediate-release (IR) tacrolimus in the UK setting. METHODS: A combined decision tree and Markov model was developed to estimate incidence of graft failure, AbMR and mortality in renal transplant recipients taking PR versus IR tacrolimus. Underlying rates of graft failure and mortality were derived from UK-specific sources. Proportions of patients adherent to once- and twice-daily tacrolimus were taken from a recent randomized trial. Relative risks of graft failure and AbMR were taken from a separate prospective analysis of 315 patients. Cost data were taken from the British National Formulary and NHS reference costs and reported in 2014 pounds sterling. RESULTS: Switching patients from IR to PR tacrolimus would result in projected cost savings of GBP 4,862 per patient over five years, translating to savings of GBP 486,200 in a hypothetical 100-patient cohort. Mean absolute per-patient costs with PR tacrolimus were projected to be GBP 40,974 versus GBP 45,836 with IR, with the largest saving arising from reduced dialysis costs, followed by reduced pharmacy and AbMR treatment costs. CONCLUSIONS: Modeling analysis showed that using PR tacrolimus in place of IR in UK renal transplant recipients was associated with lower pharmacy, dialysis and AbMR treatment costs, with the reduction in AbMR and dialysis costs being driven by improved adherence to PR tacrolimus and the consequent reductions in graft loss and onset of AbMR.
Conference/Value in Health Info
2015-05, ISPOR 2015, Philadelphia, PA, USA
Value in Health, Vol. 18, No. 3 (May 2015)
Code
PUK5
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
Urinary/Kidney Disorders