Back to Search
Start Over
Evaluation of the cost-effectiveness of sirolimus versus cyclosporin for immunosuppression after renal transplantation in the United Kingdom.
- Source :
-
Clinical therapeutics [Clin Ther] 2005 Nov; Vol. 27 (11), pp. 1834-46. - Publication Year :
- 2005
-
Abstract
- Objective: The purpose of this study was to evaluate the cost-effectiveness of sirolimus compared with cyclosporin for the postsurgical management of renal transplant recipients, from the perspective of the UK National Health Service and the Personal Social Service.<br />Methods: A discrete event stochastic simulation model was developed to evaluate both cost-effectiveness and cost utility over 10 and 20 years after transplant using historical data on 937 renal transplant recipients from the University Hospital of Wales in Cardiff, United Kingdom. The simulation was designed to forecast the incidence of acute rejection events, graft failure, retransplant, frequency of hemodialysis (HD) and peritoneal dialysis (PD), and death. Cox proportional hazard models were derived from historical transplant data, in which 1-, 2-, and 3-year post-transplant serum creatinine levels were used as the key drivers for predicting graft success and survival. Costs were reported as year-2003 UK pounds sterling (1 UK pound = US $1.76). Probabilistic sensitivity analysis was conducted and results reported with particular attention to 2 threshold values, 30,000/QALY and 20,000/QALY RESULTS: Over a 10-year time horizon, treatment with sirolimus was projected to produce a gain of 0.60 discounted year of functioning graft with a cost savings of 276 UK pounds per patient. Over a 20-year time horizon these benefits increased to 1.59 discounted years of functioning graft and a cost savings of 7405 UK pounds per patient. Using sensitivity analysis of the 10-year model, the only factors found to cause the probability of exceeding a 30,000 ceiling to be >5% were the proportion of subjects maintaining continuous graft function and the use of low-dose cyclosporin. With the 20-year model, sirolimus maintained cost-effectiveness across most scenarios in sensitivity analysis.<br />Conclusions: In this model analysis, sirolimus was cost-effective compared with cyclosporin for 10 to 20 years after renal transplantation in the United Kingdom, from the perspective of the UK National Health Service and Personal Social Service.
- Subjects :
- Adult
Cost-Benefit Analysis
Cyclosporine therapeutic use
Diabetes Complications
Female
Graft Rejection economics
Graft Rejection immunology
Graft Survival immunology
Health Care Costs
Humans
Immunosuppressive Agents therapeutic use
Male
Proportional Hazards Models
Sirolimus therapeutic use
United Kingdom
Cyclosporine economics
Immunosuppressive Agents economics
Kidney Transplantation
Sirolimus economics
Subjects
Details
- Language :
- English
- ISSN :
- 0149-2918
- Volume :
- 27
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Clinical therapeutics
- Publication Type :
- Academic Journal
- Accession number :
- 16368455
- Full Text :
- https://doi.org/10.1016/j.clinthera.2005.11.002