Economic evaluation of sirolimus-based immunosuppressive regimens in kidney graft recipients.
BACKGROUND
The aim of this study was an economic evaluation of three sirolimus (SRL)-based regimens in the first 2 years after renal transplantation.


METHODS
The three SRL-based immunosuppressive regimens in renal transplant patients between June 2000 and September 2002 were: (1) SRL + steroids + cyclosporine (CsA) permanently; (2) SRL + steroids + tacrolimus (Tac); and (3) SRL + steroids + CsA, with CsA discontinuation at 3 months posttransplant. Ten patients were included in each group in an intent-to-treat analysis. Cost was calculated according to the hospital price list and recast into euros (EUR) with a 5% discount rate.


RESULTS
The number of patients free of an acute rejection episode during 2 years posttransplant were 6, 8, and 5, with 2-year graft and patient survivals of 9, 10, and 9 for regimens 1, 2, and 3, respectively. As differences in clinical effects were not statistically significant, cost analysis was appropriate instead of cost-effectiveness analysis. The mean cost of the 2-year treatment was 15,759 EUR; 25,593 EUR; and 21,197 EUR per patient for regimens 1, 2, and 3, respectively. Sensitivity analysis for the main variables confirmed that the results were not dependent on changes in costs.


CONCLUSIONS
Regimen 1 was the most economical immunosuppressive therapy during the 2 years after kidney transplantation. Studies on a larger group of longer observation would be more useful for clinical analysis.
Niemczyk
M
M
Transplantation Institute, Department of Immunology, Transplant Medicine and Internal Diseases, Warsaw Medical University, ul. Nowogrodzka 59, 02-006 Warsaw, Poland. niemczyk@amwaw.edu.pl
Nowak
M
M
Pilecki
T
T
Wyzgał
J
J
Ziółkowski
J
J
Zygier
D
D
Paczek
L
L
D000328:Adult; D000368:Aged; D017281:Cost of Illness; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011044:Poland; D012189:Retrospective Studies; D020123:Sirolimus / Q000191:economics / Q000627:therapeutic use*; D016019:Survival Analysis; D014019:Tissue Donors / Q000145:classification
D007166:Immunosuppressive Agents; D020123:Sirolimus