Top

The European Journal of Health Economics

Published in:

01-02-2010 | Original Paper

Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: a model approach

Authors: Jan Steffen Jürgensen, Wolfgang Arns, Bastian Haß

Published in: The European Journal of Health Economics | Issue 1/2010

Abstract

Background

The choice of immunosuppression regimen is of paramount importance for outcomes and cost of renal transplantation. We compared the cost-effectiveness of triple immunosuppressive regimens in Germany.

Methods

A strong micro-simulation model was built comparing regimens based on cyclosporine, everolimus, sirolimus, and tacrolimus. Mean cost per patient, incremental cost per life year gained, and incremental cost per additional year with functioning graft were assessed from the perspective of the German statutory health insurance (SHI) after 2 and 10 years.

Results

Over the 2-year period, the model predicted mean total costs per patient of 26,732, 29,352, 33,415, and 49,978 € for sirolimus, cyclosporine, everolimus, and tacrolimus, respectively. Focusing on the cost per life year gained, the sirolimus-based regimen compared favorably with those based on everolimus and tacrolimus. The incremental cost-effectiveness ratio (ICER) of cyclosporine versus sirolimus is 524,000 € per life year gained. Regarding the cost per year with functioning graft gained, sirolimus dominated cyclosporine and everolimus, while the ICER for tacrolimus compared to sirolimus amounts to 1,788,154 €. Over the 10-year time frame, mean total costs per patient were 100,758, 108,300, 120,316, and 183,802 € for sirolimus, cyclosporine, everolimus, and tacrolimus, respectively. With regard to life years gained, sirolimus dominated both cyclosporine and everolimus. The ICER of tacrolimus versus sirolimus was 1,766,894 €. Considering the years with functioning graft gained, sirolimus dominated cyclosporine and everolimus, while the ICER for tacrolimus compared to sirolimus amounted to 1,339,419 €.

Conclusions

Over both the 2-year and the 10-year time horizon, sirolimus-based immunosuppression represents a cost-effective option in renal transplantation in Germany.

“Markov models are useful when a decision problem involves risk that is continuous over time, when the timing of events is important, and when important events may happen more than once” [14].

Grassmann, A., Gioberge, S., Moeller, S., Brown, G.: End-stage renal disease: global demographics in 2005 and observed trends. Artif. Organs 30, 895–897 (2006). doi:10.1111/j.1525-1594.2006.00321.x CrossRef

Meguid El, N.A., Bello, A.K.: Chronic kidney disease: the global challenge. Lancet 365, 331–340 (2005)

Fiebiger, W., Mitterbauer, C., Oberbauer, R.: Health-related quality of life outcomes after kidney transplantation. Health Qual. Life Out. 2, 2 (2004). doi:10.1186/1477-7525-2-2 CrossRef

Joseph, J.T., Baines, L.S., Morris, M.C., Jindal, R.M.: Quality of life after kidney and pancreas transplantation: a review. Am. J. Kidney Dis. 42, 431–445 (2003). doi:10.1016/S0272-6386(03)00740-6 CrossRef

Nagel, E., Niechzial, M.: Bewertung chirurgischer Therapien. Angemessenheit – Notwendigkeit - Zweckmäßigkeit, pp. 113–128. Springer, Berlin (1999)

Winkelmayer, W.C., Weinstein, M.C., Mittleman, M.A., Glynn, R.J., Pliskin, J.S.: Health economic evaluations: the special case of end-stage renal disease treatment. Med. Decis. Making 22, 417–430 (2002). doi:10.1177/027298902320556118

Wolfe, R.A., Ashby, V.B., Milford, E.L., et al.: Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N. Engl. J. Med. 341, 1725–1730 (1999). doi:10.1056/NEJM199912023412303 CrossRef

Woodroffe, R., Yao, G.L., Meads, C., et al.: Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study. Health Technol. Assess. 9, 1–4 (2005)

Frei, U., Schober-Halstenberg, H.J.: Nierenersatztherapie in Deutschland. Bericht über Dialysebehandlung und Nierentransplantation in Deutschland 2005/2006. http://www.quasi-niere.de/download/berichte/de/QuaSi-Niere-Bericht_2005-2006.pdf (2006)

10.

Nebel, M.: Kosten der Nierenersatztherapie. In: Hoerl, W.H., Wanner, C. (eds.) Dialyseverfahren in Theorie und Praxis, pp. 619–629. Thieme Verlag, Stuttgart (2003)

11.

Griebsch, I.: Immunosuppressive treatment following kidney transplantation. Pharm. Unserer Zeit 34, 322–330 (2005). doi:10.1002/pauz.200500132 CrossRef

12.

Knoll, G.: Trends in kidney transplantation over the past decade. Drugs 68(Suppl 1), 3–10 (2008). doi:10.2165/00003495-200868001-00002 CrossRef

13.

Hagenmeyer, E.G., Haussler, B., Hempel, E., et al.: Resource use and treatment costs after kidney transplantation: impact of demographic factors, comorbidities, and complications. Transplantation 77, 1545–1550 (2004). doi:10.1097/01.TP.0000121763.44137.FA CrossRef

14.

Sonnenberg, F.A., Beck, J.R.: Markov models in medical decision making: a practical guide. Med. Decis. Making 13, 322–338 (1993). doi:10.1177/0272989X9301300409 CrossRef

15.

Webster, A.C., Lee, V.W., Chapman, J.R., Craig, J.C.: Target of rapamycin inhibitors (sirolimus and everolimus) for primary immunosuppression of kidney transplant recipients: a systematic review and meta-analysis of randomized trials. Transplantation 81, 1234–1248 (2006). doi:10.1097/01.tp.0000219703.39149.85 CrossRef

16.

McEwan, P., Baboolal, K., Conway, P., Currie, C.J.: Evaluation of the cost-effectiveness of sirolimus versus cyclosporin for immunosuppression after renal transplantation in the United Kingdom. Clin. Ther. 27, 1834–1846 (2005). doi:10.1016/j.clinthera.2005.11.002 CrossRef

17.

Kauffman, H.M.: Malignancies in organ transplant recipients. J. Surg. Oncol. 94, 431–433 (2006). doi:10.1002/jso.20579 CrossRef

18.

Vincenti, F.: What’s in the pipeline? New immunosuppressive drugs in transplantation. Am. J. Transplant. 2, 898–903 (2002). doi:10.1034/j.1600-6143.2002.21005.x CrossRef

19.

Institut für das Entgeltsystem im Krankenhaus gGmbH (InEK). Fallpauschalen-Katalog 2007. http://www.g-drg.de/cms/index.php/inek_site_de/g_drg_system_2007/fallpauschalen_katalog/fallpauschalen_katalog_2007 (2007)

20.

Institut für das Entgeltsystem im Krankenhaus gGmbH (InEK). Abschlussbericht. Weiterentwicklung des G-DRG-Systems für das Jahr 2007. Klassifikation, Katalog und Bewertungsrelation. http://www.g-drg.de/cms/index.php/inek_site_de/g_drg_system_2007/abschlussbericht_zur_weiterentwicklung_des_drg_systems_und_report_browser/abschlussbericht_zur_weiterentwicklung_des_drg_systems_fuer_2007 (2007)

21.

22.

ifap Service-Institut für Ärzte und Apotheker GmbH. IfAP Index Praxis (Status:10/2007). 1-10-2007

23.

Vanrenterghem, Y., Ponticelli, C., Morales, J.M., et al.: Prevalence and management of anemia in renal transplant recipients: a European survey. Am. J. Transplant. 3, 835–845 (2003). doi:10.1034/j.1600-6143.2003.00133.x CrossRef

24.

von der Schulenburg, J.M., Greiner, W., Jost, F., et al.: German recommendations on health economic evaluation - third and updated version of the Hanover Consensus. Gesundh. ökon. Qual. manag. 12, 285–290 (2007)

25.

Evans, M., Hastings, N., Peacock, B.: Triangular distribution. In: Statistical distributions, pp. 187–188. Wiley, New York (2000)

26.

Naderi, M., Aslani, J., Hashemi, M., Assari, S., Amini, M., Pourfarziani, V.: Prolonged rehospitalizations following renal transplantation: causes, risk factors, and outcomes. Transplant. Proc. 39, 978–980 (2007). doi:10.1016/j.transproceed.2007.03.081 CrossRef

27.

Zeller, W.J.: Immuntherapeutika und Zytostatika. In: Schwabe, U., Paffrath, D. (eds.) Arzneiverordnungs-Report 2006. Aktuelle Daten, Kosten, Trends und Kommentare, pp. 664–677. Springer-Verlag, Berlin (2007)

28.

Kleophas, W., Reichel, H.: International study of health care organization and financing: development of renal replacement therapy in Germany. Int. J. Health Care Finan. Econ. 7, 185–200 (2007). doi:10.1007/s10754-007-9020-0 CrossRef

29.

Barbieri, M., Drummond, M., Willke, R., Chancellor, J., Jolain, B., Towse, A.: Variability of cost-effectiveness estimates for pharmaceuticals in Western Europe: lessons for inferring generalizability. Value Health 8, 10–23 (2005). doi:10.1111/j.1524-4733.2005.03070.x CrossRef

30.

Briggs, A., Gray, A.: Using cost effectiveness information. BMJ 320, 246 (2000). doi:10.1136/bmj.320.7229.246 CrossRef

31.

McEwan, P., Dixon, S., Baboolal, K., Conway, P., Currie, C.J.: Evaluation of the cost effectiveness of sirolimus versus tacrolimus for immunosuppression following renal transplantation in the UK. Pharmacoeconomics 24, 67–79 (2006). doi:10.2165/00019053-200624010-00006 CrossRef

32.

Russ, G., Jamieson, N., Oberbauer, R., et al.: Three-year health-related quality-of-life outcomes for sirolimus-treated kidney transplant patients after elimination of cyclosporine. Transpl. Int. 20, 875–883 (2007). doi:10.1111/j.1432-2277.2007.00547.x CrossRef

33.

Ekberg, H., Tedesco-Silva, H., Demirbas, A., et al.: Reduced exposure to calcineurin inhibitors in renal transplantation. N. Engl. J. Med. 357, 2562–2575 (2007). doi:10.1056/NEJMoa067411 CrossRef

34.

Nankivell, B.J., Borrows, R.J., Fung, C.L., O’Connell, P.J., Chapman, J.R., Allen, R.D.: Calcineurin inhibitor nephrotoxicity: longitudinal assessment by protocol histology. Transplantation 78, 557–565 (2004). doi:10.1097/01.TP.0000128636.70499.6E CrossRef

35.

Philips, Z., Bojke, L., Sculpher, M., Claxton, K., Golder, S.: Good practice guidelines for decision-analytic modelling in health technology assessment: a review and consolidation of quality assessment. Pharmacoeconomics 24, 355–371 (2006). doi:10.2165/00019053-200624040-00006 CrossRef

36.

Frei, U., Schober-Halstenberg, H.J.: Nierenersatztherapie in Deutschland. Bericht über Dialysebehandlung und Nierentransplantation in Deutschland 2004/2005. http://www.quasi-niere.de/download/berichte/de/QuaSi-Niere-Bericht_2004-2005.pdf (2005)

37.

Kupsch, S., Kern, A.O., Hallauer, J.F.: Versorgung von Patienten mit Nierenersatztherapie in Deutschland - Epidemiologische, medizinische und ökonomische Aspekte von Dialyse und Transplantation, pp. 161–171. Kiel Institut fuer Gesundheits-System-Forschung, Kiel (1998)

38.

Kalble, T., Lucan, M., Nicita, G., Sells, R., Burgos Revilla, F.J., Wiesel, M.: EAU guidelines on renal transplantation. http://www.uroweb.org/fileadmin/user_upload/Guidelines/23%20Renal%20Transplant.pdf (2004)

39.

Koster, I., von Ferber, L., Ihle, P., Schubert, I., Hauner, H.: The cost burden of diabetes mellitus: the evidence from Germany–the CoDiM study. Diabetologia 49, 1498–1504 (2006). doi:10.1007/s00125-006-0277-5 CrossRef

40.

Augustine, J.J., Knauss, T.C., Schulak, J.A., Bodziak, K.A., Siegel, C., Hricik, D.E.: Comparative effects of sirolimus and mycophenolate mofetil on erythropoiesis in kidney transplant patients. Am. J. Transplant. 4, 2001–2006 (2004). doi:10.1111/j.1600-6143.2004.00612.x CrossRef

Title: Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: a model approach
Authors: Jan Steffen Jürgensen
Wolfgang Arns
Bastian Haß
Publication date: 01-02-2010
Publisher: Springer-Verlag
Published in: The European Journal of Health Economics / Issue 1/2010
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-009-0148-3

At a glance: The STEP trials

Springer Medicine

Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: a model approach

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

Cost-effectiveness of infliximab for the treatment of acute exacerbations of ulcerative colitis

Cost-effectiveness of pregabalin versus venlafaxine in the treatment of generalized anxiety disorder: findings from a Spanish perspective

The added value of thorough economic evaluation of telemedicine networks

An economic model for the prevention of MRSA infections after surgery: non-glycopeptide or glycopeptide antibiotic prophylaxis?

Cost effectiveness of palivizumab in Spain: an analysis using observational data

On the welfare theoretic foundation of cost-effectiveness analysis—the case when survival is not affected