Cost-Utility Analysis of Mycophenolate Mofetil versus Azathioprine Based Regimens for Maintenance Therapy of Proliferative Lupus Nephritis

Nee, Robert; Rivera, Ian; Little, Dustin J.; Yuan, Christina M.; Abbott, Kevin C.

doi:10.1155/2015/917567

Cited by 13 publications

(38 citation statements)

References 28 publications

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“…Compared with the induction phase, a Markov structure was chosen to model transitions in the maintenance phase, which is consistent with Mohara et al and Nee et al [33,34]. This approach was preferable over a static decision-tree model as it was considered to better represent the time-dependent outcomes associated with LN, and the long time horizon.…”

Section: Discussionmentioning

confidence: 99%

“…• Four different treatment regimens combining IVCY, AZA and MMF for long-term (induction and maintenance) therapy in Thailand [33] • MMF and AZA as maintenance treatments from a US perspective [34] • MMF and IVCY as induction treatments from a UK perspective [35] Of the three identified economic models, two were Markov models with analyses conducted over a lifetime horizon [33,34] and one was a patient-level simulation to analyze only the induction phase [35]. Markov models use disease states to represent all possible consequences of an intervention.…”

Section: Model Structurementioning

confidence: 99%

“…Across the models, differentiating disease progression over time by response status was pertinent in both the induction and maintenance phases. The health states included in the previously published models were active disease, complete remission and partial remission [33,35], ESRD and death [33,34], and LN relapse [34]. As such, our cost-effectiveness model consisted of an induction phase and a maintenance phase, each containing three health states: active disease, partial remission and complete remission.…”

Section: Model Structurementioning

confidence: 99%

“…If patients had not achieved complete remission by 18 months, they transitioned to the maintenance phase. Given the time-dependent outcomes associated with LN and the chronic nature of the disease, the maintenance phase utilized a Markov model structure ( Figure 1B) [33,34], within which patients could transition back to active disease and then transition to ESRD. From ESRD patients could temporarily enter a 3-month tunnel state that included kidney transplantation followed by post-kidney transplantation.…”

Section: Model Structurementioning

confidence: 99%

“…Only AEs with a significant impact on cost or health outcomes were included in the model. The incidence of AEs occurring during treatment with each of the included interventions, and utility decrements as a result of AEs, was extracted from the literature (see Supplementary Material 2 for a summary): amenorrhea (utility decrement -0.039), menstrual abnormality (-0.039), leukopenia (-0.090), alopecia (-0.045), infection (-0.310), gastrointestinal AE (-0.006), herpes zoster (-0.280) and tremor (-0.074) [34,35,[53][54][55][56][57]. Most disutility values were not sourced from patients with SLE or LN, as data were not available.…”

Section: Quality-adjusted Life Yearsmentioning

confidence: 99%

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Cost–effectiveness of tacrolimus for the treatment of moderate-to-severe lupus nephritis in China

Kim¹,

Ooi²,

Stephens

et al. 2019

J. Comp. Eff. Res.

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Aim: Therapy for lupus nephritis (LN) requires treatment with immunosuppressive regimens, often including intravenous cyclophosphamide (IVCY), mycophenolate mofetil (MMF) or azathioprine. Additionally, tacrolimus (original form or generic) is recommended to treat LN patients in Asia, including China. However, the cost–effectiveness of tacrolimus therapy has not previously been assessed. We aimed to estimate the cost–effectiveness of tacrolimus in the treatment of moderate-to-severe LN versus standard therapies in China. Materials & methods: This cost–effectiveness model combined a decision-tree/Markov-model structure to map transitions between health states during induction and maintenance treatment phases. Induction with tacrolimus, IVCY or MMF, was followed by tacrolimus, MMF or azathioprine maintenance. Results: According to the model, during induction, complete remission rates were higher with tacrolimus versus IVCY (relative risk 1.40 vs IVCY [deterministic sensitivity analysis minimum 0.92, maximum 2.13]) and time to response was shorter. Relapse rates were lower with tacrolimus versus azathioprine or MMF during maintenance. Tacrolimus induction and maintenance was the most cost-effective regimen, incurring the lowest total costs (CN¥180,448) with the highest quality-adjusted life-years. Conclusion: The model demonstrated that tacrolimus use in both induction and maintenance therapy may be an efficacious and cost-effective treatment for LN in China.

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Section: Discussionmentioning

confidence: 99%

Section: Model Structurementioning

confidence: 99%

Section: Model Structurementioning

confidence: 99%

Section: Model Structurementioning

confidence: 99%

Section: Quality-adjusted Life Yearsmentioning

confidence: 99%

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Cost–effectiveness of tacrolimus for the treatment of moderate-to-severe lupus nephritis in China

Kim¹,

Ooi²,

Stephens

et al. 2019

J. Comp. Eff. Res.

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The Economic Burden of Lupus Nephritis: A Systematic Literature Review

Thompson¹,

Mahajan²,

Scott³

et al. 2021

Rheumatol Ther

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Introduction Few studies have evaluated the economic burden of lupus nephritis (LN). The aim of this systematic literature review (SLR) was to assess the economic burden (direct and indirect costs, and healthcare resource utilization [HCRU]) associated with LN, with particular focus on the burden of renal flares and end-stage kidney disease (ESKD). Methods This SLR (GSK study 213531) was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of the MEDLINE and Embase databases were conducted for English language publications reporting cost or HCRU data in patients with LN (regardless of age or LN histological class) until December 10, 2019. Handsearching of conference proceedings and keyword-based searches in PubMed, Google, and Google Scholar were also conducted. Results Twenty-two studies were identified from 28 publications reporting the cost ( n = 19) and HCRU ( n = 13) associated with LN. Most studies were from North America ( n = 13) and many used administrative claims data ( n = 9). LN was associated with substantially higher direct costs (e.g., total annual, hospitalization, and ESKD-related direct costs), total indirect costs, and HCRU (e.g., hospitalization, outpatient services, and medication use) compared with patients without systemic lupus erythematosus (SLE) or non-renal SLE controls. ESKD and dialysis were significant contributors to economic burden. No studies described the cost of renal flares. Conclusions The consensus across the 22 studies was that the economic burden of LN is substantial, particularly in active or severe disease, or if there is progression to ESKD. Total direct cost may be underestimated in claims data given the challenges of identifying patients with LN. Further studies are vital to ascertain the cost of renal flares; a renal flare is likely to result in a period of increased HCRU, which could be mitigated by treatments that extend renal remission. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00368-y.

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KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

Rovin¹,

Adler²,

Barratt³

et al. 2021

Kidney International

935

883

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S28 Introduction S30 Summary of recommendation statements and practice points S88 Chapter 1: General principles for the management of glomerular disease S115 Chapter 2: Immunoglobulin A nephropathy (IgAN)/immunoglobulin A vasculitis (IgAV) S128 Chapter 3: Membranous nephropathy S140 Chapter 4: Nephrotic syndrome in children S153 Chapter 5: Minimal change disease (MCD) in adults S161 Chapter 6: Focal segmental glomerulosclerosis (FSGS) in adults S172 Chapter 7: Infection-related glomerulonephritis S187 Chapter 8: Immunoglobulin-and complement-mediated glomerular diseases with a membranoproliferative glomerulonephritis (MPGN) pattern of injury S193 Chapter 9: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis S207 Chapter 10: Lupus nephritis S231 Chapter 11: Anti-glomerular basement membrane (Anti-GBM) antibody glomerulonephritis S235 Methods for guideline development S243 Biographic and disclosure information S254 Acknowledgments S256 ReferencesThis guideline is published as a supplement supported by KDIGO. The development and publication of this guideline are strictly funded by KDIGO, and neither KDIGO nor its guideline Work Group members sought or received monies or fees from corporate or commercial entities in connection with this work. The opinions or views expressed in this professional education supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the International Society of Nephrology or Elsevier. Dosages, indications, and methods of use for products that are referred to in the supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results.

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Cost-Utility Analysis of Mycophenolate Mofetil versus Azathioprine Based Regimens for Maintenance Therapy of Proliferative Lupus Nephritis

Cited by 13 publications

References 28 publications

Cost–effectiveness of tacrolimus for the treatment of moderate-to-severe lupus nephritis in China

Cost–effectiveness of tacrolimus for the treatment of moderate-to-severe lupus nephritis in China

The Economic Burden of Lupus Nephritis: A Systematic Literature Review

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

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