title: 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 their Medicare 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%. 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.
authors.affiliation: Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Yen
authors.forename: Karen
authors.initials: K
authors.lastname: Hardinger
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Woodward
authors.forename: Niraj M
authors.initials: NM
authors.lastname: Desai
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Crippin
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gage
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
mesh_terms: D003362:Cost-Benefit Analysis; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics*; D016030:Kidney Transplantation; D008390:Markov Chains; D006278:Medicare / Q000191:economics*; D013534:Survival; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents