Immunosuppressive agents in adult kidney transplantation in the National Health Service: a model-based economic evaluation

Tristan M. Snowsill, Jason Moore, Ruben E. Mujica Mota, Jaime L. Peters, Tracey L. Jones-Hughes, Nicola J. Huxley, Helen F. Coelho, Marcela Haasova, Chris Cooper, Jenny A. Lowe, Jo L. Varley-Campbell, Louise Crathorne, Matt J. Allwood, Rob Anderson, Hyde, Martin Hoyle, M Bond

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background. Immunosuppression is required in kidney transplantation to prevent rejection and prolong graft survival. We conducted an economic evaluation to support England’s National Institute for Health and Care Excellence in developing updated guidance on the use of immunosuppression, incorporating new immunosuppressive agents, and addressing changes in pricing and the evidence base.

Methods. A discrete-time state transition model was developed to simulate adult kidney transplant patients over their lifetime. A total of 16 different regimens were modelled to assess the cost-effectiveness of basiliximab and rabbit anti-thymocyte globulin (rabbit ATG) as induction agents (with no antibody induction as a comparator) and immediate-release tacrolimus, prolonged-release tacrolimus, mycophenolate mofetil, mycophenolate sodium, sirolimus, everolimus and belatacept as maintenance agents (with ciclosporin and azathioprine as comparators). Graft survival was extrapolated from acute rejection rates, graft function and post-transplant diabetes rates, all estimated at 12 months post-transplantation. National Health Service (NHS) and personal social services costs were included. Cost-effectiveness thresholds of £20 000 and £30 000 per quality-adjusted life year were used.

Results. Basiliximab was predicted to be more effective and less costly than rabbit ATG and induction without antibodies. Immediate-release tacrolimus and mycophenolate mofetil were cost-effective as maintenance therapies. Other therapies were either more expensive and less effective or would only be cost-effective if a threshold in excess of £100 000 per quality-adjusted life year were used.

Conclusions. A regimen comprising induction with basiliximab, followed by maintenance therapy with immediate-release tacrolimus and mycophenolate mofetil, is likely to be effective for uncomplicated adult kidney transplant patients and a cost-effective use of NHS resources.
Original languageEnglish
Pages (from-to)1251-1259
Number of pages9
JournalNephrology Dialysis Transplantation
Volume32
Issue number7
DOIs
Publication statusPublished - Jul 2017
Externally publishedYes

Keywords

  • Cost-effectiveness
  • Cost-utility
  • Economic model
  • Immunosuppression
  • Kidney transplantation

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