The Cost of Transplant Immunosuppressant Therapy: Is This Sustainable?

Abstract

A solid organ transplant is life-saving therapy that engenders the use of immunosuppressive medications for the lifetime of the transplanted organ and its recipient. Conventional therapy includes both induction therapy (a biologic that is infused peri-operatively) followed by maintenance therapy. The cost of these medications is a constant concern and the advent of generics has brought this cost down modestly. For those lacking long term insurance coverage, this may be a significant out of pocket expense that is not affordable. Moreover, transplant Centers are managing higher risk transplant recipients that require more complex induction regimens and longer term use of such biologic agents in the context of desensitization or abrogation of de novo antibody mediated injury. While in kidney transplantation, Medicare part B covers three years of medication, there is frequent non-adherence due to cost after that time-point. The impact of the Affordable Care Act remains uncertain at this time. Finally the pipeline of new therapies is limited due to the cost of development of a drug, the inherent cost of clinical studies, and lack of defined endpoints for newer therapies in high risk patients. These new therapies are of high value to the community but will contribute additional burden to current drug costs.

Desensitization strategies: is it worth it?

“…Treatment failure rates were 11.8% and 21.6% for the eculizumab and SOC suggesting a potential benefit for eculizumab compared with SOC in preventing acute AMR in recipients sensitized to their living‐donor kidney transplants groups. It is unfortunately quite expensive with an average wholesale price of $21 000 per dose . Another consideration is the risk of development of invasive infections with encapsulated organisms during eculizumab therapy due to which certain vaccinations are pre requisite .…”

Poverty: Not a Justification for Banning Physician‐Assisted Death

“…For example, patients requiring hematopoietic‐cell transplantation had out‐of‐pocket costs averaging $716 per month when temporary lodging was not required, and $5,247 per month when it was required . Insurance coverage, including Medicare, of immunosuppressants is limited either from medication initiation or after a certain time, costing patients up to $2,500 each year . These high costs affect decision‐making and can also discourage medication adherence .…”

Tacrolimus Utilization and Expenditure in Serbia

“…Since it is well known that immunosuppression is required for the lifetime of a solid organ transplant to prevent rejection, the cost of these medications is constant concern not only for health insurance funds but especially for those lacking long-term insurance coverage (4, 5). …”

“…Not only oral immunosuppressive agents and other necessary drugs but also insurance expenses can cost patients up to $2,500.00 per month, depending of patient clinical condition and other factors (5). In the United States, annual cost of medications accounts between $10,000 and $14,000 per patient (6).…”