Immunosuppressive agents in adult kidney transplantation in the National Health Service: A model-based economic evaluation
Background. Immunosuppression is required in kidney transplantation to prevent rejection and prolong graft survival. We conducted an economic evaluation to support England’s National Institute for Health and Care Excellence in developing updated guidance on the use of immunosuppression, incorporating new immunosuppressive agents, and addressing changes in pricing and the evidence base. Methods. A discrete-time state transition model was developed to simulate adult kidney transplant patients over their lifetime. A total of 16 different regimens were modelled to assess the cost-effectiveness of basiliximab and rabbit antithymocyte globulin (rabbit ATG) as induction agents (with no antibody induction as a comparator) and immediate-release tacrolimus, prolonged-release tacrolimus, mycophenolate mofetil, mycophenolate sodium, sirolimus, everolimus and belatacept as maintenance agents (with ciclosporin and azathioprine as comparators). Graft survival was extrapolated from acute rejection rates, graft function and post-transplant diabetes rates, all estimated at 12months post-transplantation. National Health Service (NHS) and personal social services costs were included. Cost-effectiveness thresholds of £20 000 and £30 000 per quality-adjusted life year were used. Results. Basiliximab was predicted to be more effective and less costly than rabbit ATG and induction without antibodies. Immediate-release tacrolimus and mycophenolate mofetil were cost-effective as maintenance therapies. Other therapies were either more expensive and less effective or would only be costeffective if a threshold in excess of £100 000 per quality-adjusted life year were used. Conclusions. A regimen comprising induction with basiliximab, followed by maintenance therapy with immediate-release tacrolimus and mycophenolate mofetil, is likely to be effective for uncomplicated adult kidney transplant patients and a costeffective use of NHS resources.
Citation
@article{t.m.2017,
author = {Snowsill, T. M. and Moore, J. and Mujica Mota, R. E. and
Peters, J. L. and Jones-Hughes, T. L. and Huxley, N. J. and Coelho,
H. F. and Haasova, M. and Cooper, C. and Lowe, J. A. and
Varley-Campbell, J. L. and Crathorne, L. and Allwood, M. J. and
Anderson, R.},
title = {Immunosuppressive Agents in Adult Kidney Transplantation in
the {National} {Health} {Service:} {A} Model-Based Economic
Evaluation},
journal = {Nephrology Dialysis Transplantation},
volume = {32},
number = {7},
pages = {1251-1259},
date = {2017-07-01},
url = {https://tristansnowsill.co.uk/immunosuppressive-agents-in-adult-kidney-transplantation.html},
doi = {10.1093/ndt/gfx074},
langid = {en},
abstract = {Background. Immunosuppression is required in kidney
transplantation to prevent rejection and prolong graft survival. We
conducted an economic evaluation to support England’s National
Institute for Health and Care Excellence in developing updated
guidance on the use of immunosuppression, incorporating new
immunosuppressive agents, and addressing changes in pricing and the
evidence base. Methods. A discrete-time state transition model was
developed to simulate adult kidney transplant patients over their
lifetime. A total of 16 different regimens were modelled to assess
the cost-effectiveness of basiliximab and rabbit antithymocyte
globulin (rabbit ATG) as induction agents (with no antibody
induction as a comparator) and immediate-release tacrolimus,
prolonged-release tacrolimus, mycophenolate mofetil, mycophenolate
sodium, sirolimus, everolimus and belatacept as maintenance agents
(with ciclosporin and azathioprine as comparators). Graft survival
was extrapolated from acute rejection rates, graft function and
post-transplant diabetes rates, all estimated at 12months
post-transplantation. National Health Service (NHS) and personal
social services costs were included. Cost-effectiveness thresholds
of £20 000 and £30 000 per quality-adjusted life year were used.
Results. Basiliximab was predicted to be more effective and less
costly than rabbit ATG and induction without antibodies.
Immediate-release tacrolimus and mycophenolate mofetil were
cost-effective as maintenance therapies. Other therapies were either
more expensive and less effective or would only be costeffective if
a threshold in excess of £100 000 per quality-adjusted life year
were used. Conclusions. A regimen comprising induction with
basiliximab, followed by maintenance therapy with immediate-release
tacrolimus and mycophenolate mofetil, is likely to be effective for
uncomplicated adult kidney transplant patients and a costeffective
use of NHS resources.}
}