Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil

Abstract

OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation.METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results.RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44.CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. However, regimens containing cyclosporine were more cost-effective.

Transplant Recipients Using Tacrolimus Had Higher Utilization of Healthcare Services Than Those Receiving Cyclosporine in Taiwan

“…Furthermore, unsurprisingly, outpatient study drug costs in tacrolimus users were higher than those in cyclosporine users in this study due to the higher actual wholesale price of tacrolimus (James and Mannon, 2015). Our findings are in agreement with those of previous economic studies indicating that regimens containing cyclosporine were more cost-effective than tacrolimus-based regimens in renal transplant recipients (Guerra Junior et al, 2010; Jurgensen et al, 2010; Guerra Junior et al, 2015).…”

“…Studies have shown that compared with cyclosporine, tacrolimus-based immunosuppression is associated with economic advantages among kidney or liver transplant recipients due to its lower acute rejection rates (Lake et al, 1995; Neylan et al, 1998; Rabkin et al, 2001; Lazzaro et al, 2002; Miners et al, 2007). However, cost-effectiveness analyses in Brazil and Germany have revealed that tacrolimus treatment entails higher total health service expenditures than cyclosporine treatment after renal transplantation (Jurgensen et al, 2010; Guerra Junior et al, 2015). Previous reports have indicated inconsistent economic impacts of calcineurin inhibitors on the healthcare system.…”

Ten-year kidney transplant survival of cyclosporine- or tacrolimus-treated patients in Brazil

“…In view of this, short term studies comparing tacrolimus and cyclosporine could be of limited benefit to provide guidance on their long term effectiveness and cost-effectiveness. Our initial study (26) with five years follow-up showed a clinical benefit for cyclosporine versus tacrolimus, with differences also seen in their relative cost-effectiveness with a paired analysis and five years follow-up (27) .…”

“…This non-concurrent open cohort study included patients who underwent kidney transplantation from living or deceased donors among all Brazilian transplantation centers. This cohort was developed by deterministic-probabilistic linkage of the following SUS administrative databases: Hospital Information System (SIH); Ambulatory Information System (SIA), and Mortality Information System (SIM) (26,(28)(29)(30)(31) .…”

Assessing the Functional Status of Older Cancer Patients in an Ambulatory Care Visit

“…Urinary incontinence is associated with a decline in general functional ability [ 35 ], falls [ 36 ], and is another prime factor in nursing home placement decisions [ 37 ]. A functional status assessment will help determine if incontinence exists, and possible causes.…”