The cost effectiveness of mycophenolate mofetil in the first year after living related renal transplantation

Süleymanlar, Gültekin; Tuncer, Murat; Sarıkaya, Metin; Ersoy, Fevzi; Aktan, Şükrü; Yakupoğlu, G; Karpuzoglu, Tuncer

doi:10.1016/s0041-1345(01)02189-3

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…Whether these studies reported the overall medical cost of MMF to be less or greater than azathioprine was a reflection of differences in how the studies assessed and valued these treatment costs. G Three cost-effectiveness analyses of MMF were identified, 142,[156][157][158][159][160][161][162] each of which concluded that MMF may be more cost-effective than azathioprine; compared to azathioprine, MMF was associated with better clinical outcomes for either a greater or similar overall cost. G One of these three studies reported an ICER of Can$14,268 per graft-year gained and Can$50,717 per QALY gained for MMF relative to azathioprine.…”

Section: Discussionmentioning

confidence: 99%

“…Seven economic studies assessing the costs of MMF were identified. [156][157][158][159][160][161][162] Four studies were cost-consequences studies and three were costeffectiveness analyses. All studies compared MMF to azathioprine (see Appendix 18).…”

Section: Amount Of Evidencementioning

confidence: 99%

“…Given that the studies were conducted across a number of countries (USA, Canada and Switzerland) and expressed their results in a variety of currencies, it is not readily possible to compare their costs. However, focusing on the total medical cost of MMF compared to azathioprine, five studies estimated that the short-term (6-or 12-month post-transplant) costs of MMF would exceed those of azathioprine 142,157,158,160,162 and two studies estimated that the short-term costs of azathioprine would exceed those of MMF. 156,161 The one study that modelled costs in the longer term found that as at 12 months, the 10-year costs of MMF exceeded those of azathioprine.…”

Section: Cost Analysesmentioning

confidence: 99%

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Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study

Woodroffe¹,

Yao²,

Meads³

et al. 2005

Health Technol Assess

167

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The newer immunosuppressant drugs (basiliximab, daclizumab, tacrolimus and MMF) consistently reduced the incidence of short-term (1-year) acute rejection compared with conventional immunosuppressive therapy. The independent use of basiliximab, daclizumab, tacrolimus and MMF was associated with a similar absolute reduction in 1-year acute rejection rate (approximately 15%). However, the effects of these drugs did not appear to be additive (e.g. benefit of tacrolimus with adjuvant MMF was 5% reduction in acute rejection rate compared with 15% reduction with adjuvant AZA). Thus, the addition of one of these drugs to a baseline immunosuppressant regimen was likely to affect adversely the incremental cost-effectiveness of the addition of another. The trials did not assess how the improvement in short-term outcomes (e.g. acute rejection rate or measures of graft function), together with the side-effect profile associated with each drug, translated into changes in patient-related quality of life. Moreover, given the relatively short duration of trials, the impact of the newer immunosuppressants on long-term graft loss and patient survival remains uncertain. The absence of both long-term outcome and quality of life from trial data makes assessment of the clinical and cost-effectiveness on the newer immunosuppressants contingent on modelling based on extrapolations from short-term trial outcomes. The choice of the most appropriate short-term outcome (e.g. acute rejection rate or measures of graft function) for such modelling remains a matter of clinical and scientific debate. The decision to use acute rejection in the meta-model in this report was based on the findings of a systematic review of the literature of predictors of long-term graft outcome. Only a very small proportion of the RCTs identified in this review assessed patient-focused outcomes such as quality of life. Since immunosuppressive drugs have both clinical benefits and specific side-effects, the balance of these harms and benefits could best be quantified through future trials using quality of life measures. The design of future trials should be considered with a view to the impact of drugs on particular renal transplant groups, particularly higher risk individuals and children. Finally, there is a need for improved reporting of methodological details of future trials, such as the method of randomisation and allocation concealment. A number of issues exist around registry data, for example the use of multiple drug regimens and the need to assess the long-term outcomes. An option is the use of observational registry data including, if possible, prospective data on all consecutive UK renal transplant patients. Data capture for each patient should include immunosuppressant regimens, clinical and patient-related outcomes and patient demographics.

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Section: Discussionmentioning

confidence: 99%

Section: Amount Of Evidencementioning

confidence: 99%

Section: Cost Analysesmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study

Woodroffe¹,

Yao²,

Meads³

et al. 2005

Health Technol Assess

167

View full text Add to dashboard Cite

show abstract

“…This advantage typically has been due to decreases in the number of episodes of acute rejection, the resulting cost avoidance, and decreased length of stay in the hospital among MMF-treated patients. [38][39][40][41][42][46][47][48] Mycophenolate has also been compared to everolimus. The economic analysis was based on a multicenter, international trial for prevention of rejection the first year after kidney transplantation.…”

Section: Pharmacoeconomic Analysis Of Maintenance Therapiesmentioning

confidence: 99%

Update on Pharmacoeconomics in Transplantation

Cavanaugh

Martin

2007

Prog Transpl

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“…Goals include minimizing acute rejection, and also avoiding drug nephrotoxicity, delayed graft function and medical complications of transplantation (cardiovascular disease, infections and malignancy), particularly interruption and prevention of chronic rejection. Achieving drug‐free normal allograft function has enormous medical and financial implications for patients and the health care industry (12–15). At a time when pilot clinical protocols funded by the National Institutes of Health Immune Tolerance Network (ITN, http://www.immunetolerance.org) are being tested in organ and islet cell transplant recipients (16), it is important to critically examine the potential challenges that transplant professionals will face in their quest to achieve tolerance in human beings.…”

Section: Challenges To Achieving Clinical Tolerancementioning

confidence: 99%

Transplantation tolerance in pediatric recipients: Lessons and challenges

Tinckam

Sayegh

2004

Pediatric Transplantation

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Clinical transplantation tolerance has remained an elusive goal in the 50 yr since it was first described in experimental animals. Greater understanding of the molecular mechanisms responsible for allorecognition have allowed for the development of promising immunosuppressive strategies that may bring us closer to reproducible induction of tolerance; consideration of past successes and failures from both clinical and basic science is required to define future challenges facing this field. This article reviews mechanisms of self and transplantation tolerance, translation of basic science research to clinical protocols in animals and human beings, the changing role of immunosuppression, complications following tolerance induction and controversies surrounding the choice of patients for tolerance trials with a focus on issues relevant to pediatric patients. The role of the Immune Tolerance Network is discussed along with realistic goals for tolerance induction in human beings over the next decade.

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The cost effectiveness of mycophenolate mofetil in the first year after living related renal transplantation

Cited by 10 publications

References 10 publications

Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study

Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: a systematic review and modelling study

Update on Pharmacoeconomics in Transplantation

Transplantation tolerance in pediatric recipients: Lessons and challenges

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