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

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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.

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Notes

  1. “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].

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Conflict of interest statement

Dr. Jürgensen reports receiving consulting fees and lecture fees from Wyeth, Novartis, Roche, Shire, and Spirig Pharma.

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Authors and Affiliations

  1. Department of Nephrology and Medical Intensive Care, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Jan Steffen Jürgensen

  2. Kliniken der Stadt Köln GmbH, Cologne, Germany

    Wolfgang Arns

  3. Health Economics and Outcomes Research, IMS HEALTH GmbH & Co. OHG, Nuremberg, Germany

    Bastian Haß

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  1. Jan Steffen Jürgensen
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  2. Wolfgang Arns
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Correspondence to Jan Steffen Jürgensen.

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J.S. Jürgensen, W. Arns, B. Haß contributed equally.

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Jürgensen, J.S., Arns, W. & Haß, B. Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: a model approach. Eur J Health Econ 11, 15–25 (2010). https://doi.org/10.1007/s10198-009-0148-3

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  • DOI: https://doi.org/10.1007/s10198-009-0148-3

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