Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-23T15:00:37.142Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation

Published online by Cambridge University Press:  04 July 2008

Jean-Blaise Wasserfallen ,
Mira Kast-Brückner ,
Oriol Manuel ,
Jean-Pierre Venetz ,
Pascal R. A. Meylan  and
Manuel Pascual
Jean-Blaise Wasserfallen
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Mira Kast-Brückner
Affiliation:
University of Lausanne
Oriol Manuel
Affiliation:
University of Lausanne
Jean-Pierre Venetz
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Pascal R. A. Meylan
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Manuel Pascual
Affiliation:
University of Lausanne and Lausanne University Hospital Center (CHUV)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aims of this study were to assess the 1-year cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation to prevent both rejection and infectious complications.

Methods: Patients (pts) transplanted from January 2000 to March 2003 (Group A) and treated with a conventional protocol were compared with pts submitted to a combined regimen including universal cytomegalovirus (CMV) prophylaxis between April 2003 and July 2005 (Group B). Costs were computed from the hospital accounting system for hospital stays, and official tariffs for outpatient visits. Patients with incomplete costs data were excluded from analysis.

Results: Fifty-three patients were analyzed in Group A, and 60 in Group B. Baseline characteristics including CMV serostatus were not significantly different between the two groups. Over 12 months after transplantation, acute rejections decreased from 41.5 percent in Group A to 6.7 percent in Group B (p < .001), and CMV infections from 47 percent to 15 percent (p < .001). Overall, readmissions decreased from 68 percent to 55 percent (p = .160), and average hospital days from 28 ± 19 to 20 ± 11 days (p < .007). The average number of outpatient visits decreased from 49 ± 10 to 39 ± 8 (p < .001). Average 1-year immunosuppressive and CMV prophylaxis costs (per patient) increased from CHF20,402 ± 7,273 to 27,375 ± 6,063 (p < .001), graft rejection costs decreased from CHF4,595 ± 10,182 to 650 ± 3,167 (p = .005), CMV treatment costs from CHF2,270 ± 6,161 to 101 ± 326 (p = .008), and outpatient visits costs from CHF8,466 ± 1’721 to 6,749 ± 1,159 (p < .001). Altogether, 1-year treatment costs decreased from CHF39’957 ± 16,573 to 36,204 ± 6,901 (p = .115).

Conclusions: The new combined regimen administered in Group B was significantly more effective, and its additional costs were more than offset by savings associated with complications avoidance.

Keywords

Cost-effectivenessImmunosuppressionGraft rejectionCMV infectionKidney transplantation
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 3 , July 2008 , pp. 312 - 317
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Alangaden, GJ, Thyagarajan, R, Gruber, SA, et al. Infectious complications after kidney transplantation: Current epidemiology and associated risk factors. Clin Transplant. 2006;20:401–409.CrossRefGoogle ScholarPubMed
2. Craig, AM, McKechnie, T, McKenna, M, et al. A Cost-effectiveness analysis of tacrolimus versus Cciclosporine microemulsion following kidney transplantation. Transplant Proc. 2002;34:1646–1648.CrossRefGoogle ScholarPubMed
3. Fishman, JA, Rubin, RH. Infection in organ-transplant recipients. N Engl J Med. 1998;338:1741–1751.CrossRefGoogle ScholarPubMed
4. Gane, E, Saliba, F, Valdecasas, GJ, et al. Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. The Oral Ganciclovir International Transplantation Study Group [corrected]. Lancet. 1997;350:1729–1733.CrossRefGoogle ScholarPubMed
5. Hagenmeyer, E, Häussler, B, Hempel, E, et al. Resource use and treatment costs after kidney transplantation. Impact of demographic factors, comorbidities, and complications. Transplantation. 2004;77:1545–1550.CrossRefGoogle ScholarPubMed
6. Hardinger, KL, Bohl, DL, Schnitzler, MA, et al. A randomized, prospective, pharmacoeconomic trial of tacrolimus versus cyclosporine in combination with thymoglobulin in kidney transplant recipients. Transplantation. 2005;80:41–46.CrossRefGoogle Scholar
7. Hart, GD, Paya, CV. Prophylaxis for CMV should now replace preemptive therapy in solid organ transplantation. Rev Med Virol. 2001;11:73–81.CrossRefGoogle ScholarPubMed
8. Khoury, JA, Storch, GA, Bohl, DL, et al. Prophylactic versus preemptive oral valganciclovir for the management of cytomegalovirus infection in adult renal transplant recipients. Am J Transplant. 2006;6:2134–2143.CrossRefGoogle ScholarPubMed
9. Koetz, A, Delbruck, R, Furtwangler, A, et al. Cytomegalovirus pp65 antigen-guided preemptive therapy with ganciclovir in solid organ transplant recipients: A prospective, double-blind, placebo-controlled study. Transplantation. 2001;72:1325–1327.CrossRefGoogle ScholarPubMed
10. Lazzaro, C, McKechnie, T, McKenna, M. Tacrolimus versus ciclosporin in renal transplantation in Italy: Cost-minimization and cost-effectiveness analyses. J Nephrol. 2002;15:580–588.Google Scholar
11. Legendre, CM, Norman, DJ, Keating, MR, et al. Valaciclovir prophylaxis of cytomegalovirus infection and disease in renal transplantation: An economic evaluation. Transplantation. 2000;70:1463–1468.CrossRefGoogle ScholarPubMed
12. Magee, C, Pascual, M. Update in renal transplantation. Arch Intern Med. 2004;164:1373–1388.CrossRefGoogle ScholarPubMed
13. Manuel, O, Venetz, JP, Fellay, J, et al. Efficacy and safety of universal valganciclovir prophylaxis combined with a tacrolimus/mycophenolate based regimen in kidney transplantation. Swiss Med Wkly. 2007;137:669–676.Google ScholarPubMed
14. Mauskopf, JA, Richter, A, Annemans, L, et al. Cost-effectiveness model of cytomegalovirus management strategies in renal transplantation. Comparing valaciclovir prophylaxis with current practice. Pharmacoeconomics. 2000;18:239–251.CrossRefGoogle ScholarPubMed
15. Morris-Stiff, G, Richards, T, Singh, J, et al. Pharmaco-economic study of FK 506 (Prograf) and cyclosporin A Neoral in cadaveric renal transplantation. Transplant Proc. 1998;30:1285–1286.CrossRefGoogle ScholarPubMed
16. Muheim, C, Vogel, G, Seydoux, C, et al. Determinants of protracted cytomegalovirus infection in solid-organ transplant patients. Transplantation. 2002;74:226–236.CrossRefGoogle ScholarPubMed
17. Nett, PC, Heisey, DM, Fernandez, LA, et al. Association of cytomegalovirus disease and acute rejection with graft loss in kidney transplantation. Transplantation. 2004;78:1036–1041.CrossRefGoogle ScholarPubMed
18. Offermann, G. Immunosuppression for long-term maintenance of renal allograft function. Drugs. 2004;64:1325–1338.CrossRefGoogle ScholarPubMed
19. Paya, C, Humar, A, Dominguez, E, et al. Efficacy and safety of valganciclovir versus oral ganciclovir for prevention of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2004;4:611–620.CrossRefGoogle Scholar
20. Snydman, DR. The case for cytomegalovirus prophylaxis in solid organ transplantation. Rev Med Virol. 2006;16:289–295.CrossRefGoogle ScholarPubMed
21. Swiss drug compendium. Morant J, Ruppanner H, eds. 27th ed, Documed, Basel, 2006. http://www.kompendium.ch. Accessed 6 December 2007.Google Scholar
22. Tarmed. Swiss medical tariff. http://www.tarmed.ch. Accessed 6 December 2007.Google Scholar
23. Webster, AC, Woodroffe, RC, Taylor, RS, Chapman, JR, Craig, JC. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplantation recipients: Meta-analysis and meta-regression of randomised trial data. BMJ. 2005;331;810.CrossRefGoogle ScholarPubMed