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Cost-effectiveness of modern mTOR inhibitor based immunosuppression compared to the standard of care after renal transplantation in Germany

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Abstract

Objectives

Standards of immunosuppression in renal transplantation have changed dynamically in recent years. We here provide a refined advanced pharmacoeconomic model which uses state-of-the-art methods including a mixed treatment comparison (MTC) analysis. The aim was to assess the cost-effectiveness of current immunosuppressive therapy regimens (TR): “sirolimus + early withdrawal of cyclosporine + steroids” (TR1), “sirolimus–early transition” (TR2), “everolimus–early transition” (TR3) and “tacrolimus low dose + mycophenolate mofetil (MMF) + steroids” (TR4).

Methods

An up-to-date Markov model with current source data was employed to assess the cost-effectiveness of modern immunosuppressive regimens over 12-month and 10-year time periods. Transition probabilities for the occurrence of events for the first year were based on an MTC analysis. The robustness of the model was tested in extensive sensitivity analyses.

Results

Within the 12-month time period TR2 yields the highest life years (0.987 LY), generating costs of 17,500 €. In terms of years with functioning graft (FG), TR4 yields the best efficacy over the 12-month model duration (0.970 years with FG). For the 10-year time period, TR2 yields the lowest costs (107,246 €) and dominates both TR3 and TR1, as it is simultaneously more effective. Within the 10-year model duration, TR4 reaches slightly higher effects compared with TR2 (6.493 vs. 6.474 LY) resulting in an incremental cost-effectiveness ratio of 387,684 € per LY gained.

Conclusions

The early transition to sirolimus provides long-term efficiency results comparable with a tacrolimus-based regimen, which represents a common treatment standard after kidney transplantation. Both are superior to other investigated immunosuppressive regimens.

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Abbreviations

CAN:

Chronic allograft nephropathy

CEAC:

Cost-effectiveness acceptability curve

CMV:

Cytomegalovirus

CNI:

Calcineurin inhibitor

CRD:

Centre for Reviews and Dissemination

DRG:

Diagnosis related groups

DSO:

German Foundation of Organ Transplantation

EC-MPS:

Enteric-coated mycophenolate sodium

EUR (€):

Euros

FG:

Functioning graft

HAS:

Haute Autorité de Santé

HMGCoA:

3-Hydroxy-3-methylglutaryl coenzyme A reductase

ICER:

Incremental cost-effectiveness ratio

IQWiG:

Institute for Quality and Efficiency in Health Care

ITT:

Intention-to-treat principle

LY:

Life years

LYG:

Life years gained

MC:

Monte Carlo error

McMC:

Markov chain Monte Carlo method

MMF:

Mycophenolate mofetil

MTC:

Mixed treatment comparison

mTOR:

Mammalian target of rapamycin

OR:

Odds ratio

PSA:

Probabilistic sensitivity analysis

RCT:

Randomized controlled trial

SHI:

Statutory health insurance

TR:

Therapy regimen

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Acknowledgments

This study was funded by an unrestricted grant from Pfizer Pharma GmbH, Berlin, Germany.

Conflict of interest

Dr. Jürgensen received grants and honoraria from Novartis, Pfizer, Roche, Shire, Spirig Pharma, Galderma and Wyeth.

Author information

Authors and Affiliations

  1. Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Jan Steffen Jürgensen

  2. Hochschule für Oekonomie und Management, 10625, Berlin, Germany

    Jan Steffen Jürgensen

  3. IMS HEALTH GmbH & Co. OHG, Erika-Mann-Strasse 5, 80636, Munich, Germany

    Robert Ikenberg & Roger-Axel Greiner

  4. StatSciConsult, Maillingerstr. 8, 80636, Munich, Germany

    Volker Hösel

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  1. Jan Steffen Jürgensen
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  2. Robert Ikenberg
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  3. Roger-Axel Greiner
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Correspondence to Jan Steffen Jürgensen.

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Jürgensen, J.S., Ikenberg, R., Greiner, RA. et al. Cost-effectiveness of modern mTOR inhibitor based immunosuppression compared to the standard of care after renal transplantation in Germany. Eur J Health Econ 16, 377–390 (2015). https://doi.org/10.1007/s10198-014-0579-3

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  • DOI: https://doi.org/10.1007/s10198-014-0579-3

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