The European Journal of Health Economics

, Volume 16, Issue 4, pp 377–390 | Cite as

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

  • Jan Steffen Jürgensen
  • Robert Ikenberg
  • Roger-Axel Greiner
  • Volker Hösel
Original Paper
First Online:
Received:
Accepted:

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.

Keywords

Mixed treatment comparison Cost-effectiveness Modelling Germany  Sirolimus Immunosuppressive regimens Renal transplant 

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

JEL Classification

I10 E17 C11 C15 
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Notes

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.

Supplementary material

10198_2014_579_MOESM1_ESM.doc (130 kb)
Supplementary material 1 (DOC 130 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Jan Steffen Jürgensen
    • 2
    • 1
  • Robert Ikenberg
    • 3
  • Roger-Axel Greiner
    • 3
  • Volker Hösel
    • 4
  1. 1.Department of Nephrology and Medical Intensive CareCharité-Universitätsmedizin BerlinBerlinGermany
  2. 2.Hochschule für Oekonomie und ManagementBerlinGermany
  3. 3.IMS HEALTH GmbH & Co. OHGMunichGermany
  4. 4.StatSciConsultMunichGermany

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