Cost-Related Immunosuppressive Medication Nonadherence Among Kidney Transplant Recipients

Evans, Roger W.; Applegate, William H.; Briscoe, David M.; Cohen, David J.; Rorick, Christopher; Murphy, Barbara; Madsen, Joren C.

doi:10.2215/cjn.04220510

Cited by 95 publications

(82 citation statements)

References 23 publications

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“…Furthermore, difficulty paying medical bills is an increasing issue in a number of countries 61. Responding to a survey, 70% of kidney transplant programs in the United States reported that patients had difficulties paying for their medication 62. As health insurance status was not retained in our analysis, previous evidence from US studies correlating insurance status inversely with nonadherence was not confirmed 9, 11…”

Section: Discussionmentioning

confidence: 83%

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Denhaerynck

Berben

Dobbels

et al. 2018

American Journal of Transplantation

100

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Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4‐continent, 11‐country cross‐sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants—defined as any deviation in taking or timing adherence and/or dose reduction—was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS ©) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health‐related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out‐of‐pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.

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Section: Discussionmentioning

confidence: 83%

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Denhaerynck

Berben

Dobbels

et al. 2018

American Journal of Transplantation

100

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“…This finding may help explain the documented lower access to transplantation among rural kidney patients (25). Concerns that dialysis patients who are of low SES might be unable to pay for the costs of immunosuppressant drugs in the future may be preventing some educators from educating patients about this treatment option (26). Future research must continue to examine whether these trends persist in a national sample of dialysis centers.…”

Section: Discussionmentioning

confidence: 95%

Assessing Transplant Education Practices in Dialysis Centers

Waterman

Peipert

Goalby

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates.Design, setting, participants, & measurements Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression.Results According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates.Conclusions While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.

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“…Return to dialysis and re-transplantation have staggering adverse economic consequences. In the year a kidney transplant recipient's graft fails, a 2009 study of third party payer costs revealed an average annual expense of $92,443 [11]. If the patient returns to dialysis, the average annual expense is $75,836, and, if the patient is re-transplanted, the average cost is $111,891.…”

Section: Resultsmentioning

confidence: 99%

“…The annualized cost of transplantation over 10 years is less than 25% of the cost of dialysis ($16,844 versus $70,581) [11]. Solving the problem of graft loss would create savings to payers (public and private combined) of more than $3.4 billion per year [2].…”

Section: Discussionmentioning

confidence: 99%

An Economic Analysis of the Cost Effectiveness of Blood Gene Expression Profiling in Kidney Transplant Recipients

M¹,

Lee²,

Lewis³

et al. 2017

J Health Med Econ

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Background: Significant challenges exist to detecting kidney injury early in patients with kidney transplants. The current standard of care includes monitoring serum creatinine levels and immunosuppressive drug levels, both of which are poor early predictors of kidney graft damage. Protocol (surveillance) biopsies provide an accurate assessment of the transplanted kidney but are expensive, invasive, risking infection and bleeding and even graft loss, such that they are unsuited for frequent monitoring.

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Cost-Related Immunosuppressive Medication Nonadherence Among Kidney Transplant Recipients

Cited by 95 publications

References 23 publications

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Assessing Transplant Education Practices in Dialysis Centers

An Economic Analysis of the Cost Effectiveness of Blood Gene Expression Profiling in Kidney Transplant Recipients

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