Cost of renal transplant maintenance immunosuppression: effect of control of vascular risk factors.
In 3 renal transplant cohorts treated in Spain in 1990, 1994, and 1998 (total number, 3279), we studied the frequency of certain cardiovascular risk factors. Their effect on the cost of drugs was assessed from the data from 1 center; the mean cost of antihypertensive agents per patient-year was 349 euros, and of lipid-lowering drugs was 294 euros. Between 1990 and 1998 the frequency of use of antihypertensive agents at 2 years increased from 70% to 80%, and that of lipid-lowering agents from 12% to 46% (P < .001). Patients received various regimens of immunosuppression at the second year, as follows: (1) steroid-free: cyclosporine, 2.3%; tacrolimus, 9.9%; cyclosporine plus mycophenolate, 16.2%; and tacrolimus plus mycophenolate, 11.8% (P < .001); (2) antihypertensive agents: 74.9% of patients receiving tacrolimus, with or without mycophenolate, versus 80.7% of those receiving cyclosporine (P = .022); (3) lipid-lowering drugs: 28.4% of patients receiving tacrolimus, with or without mycophenolate, versus 51.1% of those receiving cyclosporine (P < .001). The increase in associated drug costs must be added to the recent large increase in the cost for immunosuppressive agents, which rose from 3854 euros per year, in 1990 to 5374 euros per year in 1998. A lower cost of associated drugs tends to lessen the overall cost of therapies with tacrolimus. Because cardiovascular disease is the main cause of death, these findings should be taken into account in the assessment of the long-term cost-benefit ratio.
Gentil
M A
MA
Spanish Group for the Study of Predictive Factors of Chronic Allograft Nephropathy, Seville, Spain. mgentil@cica.es
López
M
M
González-Roncero
F
F
Cantarell
C
C
Marco
J
J
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000191:economics*; D016030:Kidney Transplantation / Q000191:economics / Q000276:immunology*; D011183:Postoperative Complications / Q000517:prevention & control; D013030:Spain
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents