Cost-Effectiveness of Extending Medicare Coverage of Immunosuppressive Medications to the Life of a Kidney Transplant

Abstract

Unless they maintain Medicare status through disability or age, kidney transplant recipients lose theirMedicare coverage of immunosuppression 3 years after transplantation. A significant transplant survival advantage has previously been demonstrated by the extension of Medicare immunosuppressive medication coverage from 1 year to 3 years, which occurred between 1993 and 1995. The United States Renal Data System (USRDS) was analyzed for recipients of kidney transplants from 1995 to 1999. Using a Markov model, we estimated survival and costs of the current system of 3-year coverage compared with lifetime immunosuppression coverage. Results were calculated from the perspectives of society and Medicare. Extension of immunosuppression coverage produced an expected improvement from 38.6% to 47.6% in graft survival and from 55.4% to 61.8% in patient survival. The annualized expected savings to society from lifetime coverage was $136 million assuming current rates of transplantation. Medicare would break-even compared with current coverage if the fraction of patients using extended coverage was <32%. The extension would be cost-effective to Medicare if this fraction was <91%.Data reported here were supplied by the United States Renal Data System (USRDS). Interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. Government.Extended Medicare immunosuppression coverage to the life of a kidney transplant should result in better transplant and economic outcomes, and should be considered by policy makers.

Role of Socioeconomic Status in Kidney Transplant Outcome

“…Woodward et al (24) have shown that extending the coverage from 1 yr to 3 yr posttransplantation has eliminated the 4.5% difference in graft survival between low-income and high-income recipients. In a follow-up analysis (25), the same authors estimated that if Medicare provided life-long immunosuppressive medications to all of the recipients, then graft failure would be reduced by 1.2% annually beginning in the fourth year posttransplantation. Furthermore, Medicare beneficiaries who are eligible to receive the immunosuppressive medication coverage must still pay 20% of the cost of these medications as Medicare covers only 80% of the total cost.…”

Managing Specialty Medication Services Through a Specialty Pharmacy Program: The Case of Oral Renal Transplant Immunosuppressant Medications

“…Complications due to nonadherence can result in increased physician visits and inpatient hospitalization stays and, in cases of kidney transplantation failures, re-initiation of dialysis, all culminating in increased overall health care costs. [11][12][13][14][15] Immunosuppressant therapy is costly, with an annual medication regimen expense of approximately $30,000 during the first year after transplantation and $15,000 every year thereafter. 16,17 In order to improve quality of care and possibly reduce overall medical costs, health plans are looking increasingly to specialty pharmacy programs and/or specialty pharmacies to address the challenges of managing transplant patients taking oral immunosuppressive therapy.…”

Improving transplant education in the dialysis setting: the “explore transplant” initiative

“…[2][3][4][5][6][7] After 5 years, only 35% of dialysis patients are still living, compared with 70% to 80% of patients who receive a deceased or living-donor transplant. 1 Thus, to promote ongoing quality improvement, the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage (CfC) for ESRD Facilities mandate that accredited dialysis centers provide evidence of transplant education, track patients' transplant referrals and status on the waiting list, and communicate with transplant facilities regularly ( Table I).…”