Lack of Economic Benefit with Basiliximab Induction in Living Related Donor Adult Renal Transplant Recipients

Crompton, Jason A.; Somerville, Troy; Smith, Leslie F.; Corbett, J; Nelson, Edward William; Holman, John; Shihab, Fuad S.

doi:10.1592/phco.23.4.443.32119

Cited by 12 publications

(9 citation statements)

References 26 publications

(22 reference statements)

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“…Twelve economic evaluations were included in the review (published in 14 publications 65,306,[308][309][310][311][312][313][314][315][316][319][320][321] ). Update searches, conducted on 18 November 2014, yielded an additional six reports 42,307,318,324,325 on economic evaluations eligible for inclusion in the review.…”

Section: Identified Studiesmentioning

confidence: 99%

“…Thirteen studies 65,[307][308][309][310]312,[314][315][316][317][318][319]321 were included in this review. Five were studies of induction regimens, 312,[314][315][316][317] three of which were studies of UK adults, [315][316][317] and 10 were studies of initial and maintenance immunosuppression, 65,[307][308][309][310]318,319,321 four of which were of UK adults.…”

Section: Identified Studiesmentioning

confidence: 99%

“…Five were studies of induction regimens, 312,[314][315][316][317] three of which were studies of UK adults, [315][316][317] and 10 were studies of initial and maintenance immunosuppression, 65,[307][308][309][310]318,319,321 four of which were of UK adults. 65,309,310,318 In what follows, studies of induction regimens are reviewed before reviewing studies of initial and maintenance immunosuppressive regimens, by country setting (UK vs. other).…”

Section: Identified Studiesmentioning

confidence: 99%

“…The study 312 evaluated differences in resource use using charges as opposed to economic costs of the resources consumed. Payments for readmissions were derived from DRG (diagnosis-related group) tariffs.…”

Section: Crompton Et Al 2003mentioning

confidence: 99%

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Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect®, Novartis Pharmaceuticals UK Ltd) and rabbit anti-human thymocyte immunoglobulin (rATG) (Thymoglobulin®, Sanofi) as induction therapy, and immediate-release tacrolimus (TAC) (Adoport®, Sandoz; Capexion®, Mylan; Modigraf®, Astellas Pharma; Perixis®, Accord Healthcare; Prograf®, Astellas Pharma; Tacni®, Teva; Vivadex®, Dexcel Pharma), prolonged-release tacrolimus (Advagraf®Astellas Pharma), belatacept (BEL) (Nulojix®, Bristol-Myers Squibb), mycophenolate mofetil (MMF) (Arzip®, Zentiva; CellCept®, Roche Products; Myfenax®, Teva), mycophenolate sodium (MPS) (Myfortic®, Novartis Pharmaceuticals UK Ltd), sirolimus (SRL) (Rapamune®, Pfizer) and everolimus (EVL) (Certican®, Novartis) as maintenance therapy in adult renal transplantation.MethodsClinical effectiveness searches were conducted until 18 November 2014 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science (via ISI), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted until 18 November 2014 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Database (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and the American Economic Association’s electronic bibliography (via EconLit, EBSCOhost). Included studies were selected according to predefined methods and criteria. A random-effects model was used to analyse clinical effectiveness data (odds ratios for binary data and mean differences for continuous data). Network meta-analyses were undertaken within a Bayesian framework. A new discrete time–state transition economic model (semi-Markov) was developed, with acute rejection, graft function (GRF) and new-onset diabetes mellitus used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsEighty-nine randomised controlled trials (RCTs), of variable quality, were included. For induction therapy, no treatment appeared more effective than another in reducing graft loss or mortality. Compared with placebo/no induction, rATG and BAS appeared more effective in reducing biopsy-proven acute rejection (BPAR) and BAS appeared more effective at improving GRF. For maintenance therapy, no treatment was better for all outcomes and no treatment appeared most effective at reducing graft loss. BEL + MMF appeared more effective than TAC + MMF and SRL + MMF at reducing mortality. MMF + CSA (ciclosporin), TAC + MMF, SRL + TAC, TAC + AZA (azathioprine) and EVL + CSA appeared more effective than CSA + AZA and EVL + MPS at reducing BPAR. SRL + AZA, TAC + AZA, TAC + MMF and BEL + MMF appeared to improve GRF compared with CSA + AZA and MMF + CSA. In the base-case deterministic and probabilistic analyses, BAS, MMF and TAC were predicted to be cost-effective at £20,000 and £30,000 per quality-adjusted life-year (QALY). When comparing all regimens, only BAS + TAC + MMF was cost-effective at £20,000 and £30,000 per QALY.LimitationsFor included trials, there was substantial methodological heterogeneity, few trials reported follow-up beyond 1 year, and there were insufficient data to perform subgroup analysis. Treatment discontinuation and switching were not modelled.Future workHigh-quality, better-reported, longer-term RCTs are needed. Ideally, these would be sufficiently powered for subgroup analysis and include health-related quality of life as an outcome.ConclusionOnly a regimen of BAS induction followed by maintenance with TAC and MMF is likely to be cost-effective at £20,000–30,000 per QALY.Study registrationThis study is registered as PROSPERO CRD42014013189.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Identified Studiesmentioning

confidence: 99%

Section: Identified Studiesmentioning

confidence: 99%

Section: Identified Studiesmentioning

confidence: 99%

Section: Crompton Et Al 2003mentioning

confidence: 99%

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Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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“…There is no economic benefit of basiliximab induction in adult living-related kidney transplant recipients and no differences in the incidence of acute rejection, renal function, or frequency of infectious complications between recipients of living-donor kidney transplant with or without induction. 38 However, induction is important in livingunrelated kidney transplant. There is a higher frequency of acute rejection after 6 and 12 months, and a 3-fold greater risk of rejection, with livingunrelated kidney transplant without induction than deceased-donor kidney transplant with induction.…”

Section: Living Donorsmentioning

confidence: 99%

Induction Immunosuppressive Therapy in Kidney Transplantation

Bakr

Nagib²,

Donia³

2014

Exp Clin Transplant

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Induction therapy after kidney transplantation is intensive immunosuppression in the initial days after transplant when the immune system of the recipient has the first contact with donor antigens. Initial intensive immunosuppression may be required to prevent acute rejection and graft loss, and subsequent immuno-suppression may be decreased to minimize adverse events associated with immunosuppressive drugs. Induction agents include lymphocyte-depleting antibodies such as rabbit antithymocyte globulin, alemtuzumab, muromonab-CD3, rituximab, and bortezomib; lymphocytenondepleting antibodies such as interleukin 2 receptor antibodies; and other discontinued or investigational agents such as efalizumab and alefacept. Induction therapy may be adjusted for special situations such as living-donor kidney transplant, pediatric transplant, hepatitis C virusseropositive recipients, recipients who require desensitization, patients who are at risk for developing delayed graft function, and old donors. The optimal immunosuppressive regimen may vary, and clinical practice guidelines are available.

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Basiliximab

2006

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions

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Lack of Economic Benefit with Basiliximab Induction in Living Related Donor Adult Renal Transplant Recipients

Abstract: Basiliximab induction therapy did not provide clear clinical efficacy benefit or prove to be cost-effective compared with no induction in LRD recipients.

Cited by 12 publications

References 26 publications

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Induction Immunosuppressive Therapy in Kidney Transplantation

Basiliximab

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