PUK20 Cost-Utility Assessment of Sirolimus Versus Tacrolimus for Primary Prevention of Graft Rejection in Renal Transplant Recipients in Mexico

Abstract

with pharmacist-managed ESA clinics (nϭ314) and at six sites with usual care only (nϭ167); outpatients were followed for 6 months in 2009. We took a VA perspective with projections over a five-year time horizon; costs and effectiveness values were discounted at 3%/yr. Strategy-specific likelihoods of target range hemoglobin values (10-12 g/dl) were based on study results. Utilities for ND-CKD and ESA-related adverse events and their likelihood were obtained from the literature. ESA costs were based on average monthly epoetin and darbepoetin doses per patient during the study and VA ESA cost data. RESULTS: In the base case analysis, cost and effectiveness were $12,500 and 2.096 quality-adjusted life-years (QALYs) in the pharmacistmanaged ESA clinics and $15,500 and 2.093 QALYs in usual care; ESA clinics dominated usual care. In one-way sensitivity analyses, ESA clinics no longer dominated if their patients' probability of being in the target range fell to 0.54 (base case 0.71) or if the mean cost/month of epoetin or darbepoetin in ESA clinics increased to approximately $360 (base case $211) or $460 (base case $250), respectively. When all parameters were varied simultaneously in a probabilistic sensitivity analysis, ESA clinics were favored Ն80% of the time regardless of willingness-to-pay threshold. CONCLUSIONS: Pharmacist-managed ESA clinics were less costly and more effective than usual care in patients receiving ESAs for anemia and ND-CKD. Results were robust to variation and support the use of pharmacist-managed ESA clinics.

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

“…One of the included studies compared immediate-release TAC with TAC-PR (this study is reviewed in section 1.2 of the company's submission). 321 Four studies compared TAC with CSA (three 309,319,320 of which met the criteria for inclusion in the review of section 1.2; the remaining study 100 was excluded from the review of section 1.2 because it measured costs only for medication) and seven studies [306][307][308]311,[351][352][353] examined SRL in CNI avoidance or minimisation strategies compared with TAC (four studies 307,308,311 included in the review of section 1.2) and three studies [351][352][353] that were excluded from it as a result of the country to which they apply.…”

“…No assessment of their strengths and weakness was presented. These models 308,351,352 share the characteristics of models described and discussed in Assessment of cost-effectiveness (one of them 308 is reviewed in that section).…”

Immunosuppressive therapy for kidney transplantation in children and adolescents: systematic review and economic evaluation

“…One of the included studies compared TAC-IR with TAC-PR (US study 140 ); four studies compared TAC with CSA (two in continental Europe, 141,142 one in the UK 143 and the remaining study was from the USA and measured only costs of medication 113 ); seven studied SRL in CNI avoidance or minimisation strategies versus TAC (one from the USA, 144 another from the UK, 145 two more from Germany 146,147 and three studies from Colombia, Mexico and Poland [148][149][150] ).…”

“…The submission also includes a section where three published models are described. 144,148,149 No assessment of their strengths and weakness was presented. These models are all of adult patient populations and are therefore not included in the review of cost-effectiveness studies of this monograph.…”