Cost evaluation of basiliximab treatment for renal transplant patients in Japan.
BACKGROUND
International phase III studies (CHIB 201 and 352) showed that basiliximab, a high affinity chimeric monoclonal antibody interleukin-2 receptor antagonist, is highly effective in preventing acute rejection when used as immunoprophylaxis in patients receiving cyclosporin (Neoral). We conducted a cost evaluation by applying international clinical results to standard Japanese medical practice.


OBJECTIVE
To evaluate the impact of basiliximab in renal transplant patients receiving conventional immunosuppressive therapy using cyclosporin and corticosteroids from the perspective of the healthcare payer in Japan.


METHODS
A decision tree model was developed, comprising seven pathways with key clinical events identified after the transplantation. The average first-year treatment costs after transplantation for patients treated with and without basiliximab were calculated using the model. A sensitivity analysis was done to measure the degree of influence of several criteria including the incidences of rejection, and rejection responding to steroid pulse therapy and antibody therapy.


METHODS
Estimates of key clinical events were derived from the international studies. Calculation of direct medical costs were made from the payers' perspective, based on the Social Insurance Medical Fee Table in Japan. The cost of basiliximab was assumed as zero.


RESULTS
Basiliximab use produced an estimated saving of 315,807 yen (2000 values) during the first year after transplantation. Reduced acute rejection treatment and dialysis most influenced the cost saving. The sensitivity analysis showed that the average cost for a patient was lower in the basiliximab group and that the model was effective within the plausible range of each criterion that would reflect renal transplantation in Japan.


CONCLUSIONS
If the cost of basiliximab is less than 315,807 yen, the clinical and economic benefits of basiliximab in the first year after transplantation support the routine use of basiliximab in renal transplantation in Japan.
Hasegawa
Tomonori
T
Department of Public Health, Toho University School of Medicine, Tokyo, Japan. tommie@med.toho-u.ac.jp
Imai
Hidehiko
H
Miki
Sunao
S
D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use*; D000077552:Basiliximab; D016572:Cyclosporine / Q000191:economics / Q000627:therapeutic use; D003663:Decision Trees; D004180:Direct Service Costs; D016527:Drug Costs; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use*; D007564:Japan; D016030:Kidney Transplantation / Q000191:economics* / Q000276:immunology*; D009392:Nephrectomy / Q000191:economics; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins; D006435:Renal Dialysis / Q000191:economics; D012680:Sensitivity and Specificity; D014019:Tissue Donors / Q000145:classification
D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D016572:Cyclosporine; D000077552:Basiliximab; D011241:Prednisone