Cost comparison between mycophenolate mofetil and cyclophosphamide-azathioprine in the treatment of lupus nephritis.
OBJECTIVE
To compare the healthcare expenditure associated with mycophenolate mofetil (MMF)-based immunosuppression in contrast to conventional therapy in patients with lupus nephritis.


METHODS
Our retrospective single-center study compared the major healthcare costs during the first 24 months of treatment incurred by immunosuppressive medications, hospitalization, and complications in patients with severe lupus nephritis who had been treated with prednisolone and either MMF or sequential cyclophosphamide induction followed by azathioprine maintenance (CTX-AZA).


RESULTS
Forty-four patients were studied (22 in each group). Baseline demographic and clinical measures, and remission rates after treatment, were similar between the 2 groups. Immunosuppressive drug cost was 13.6-fold higher in the MMF group (US$4168.3+/-1176.5 per patient, compared with $285.0+/-70.6 in the CTX-AZA group, mean difference $3883.2+/-251.3; p<0.001). MMF treatment was associated with a lower incidence of infections (12.0 episodes/1000 patient-months, compared with 32.4 in the CTX-AZA group; p=0.035). Combined cost of hospitalization and treatment of infections was 82.5% lower in the MMF group (mean difference -2208.7+/-1700.6; p=0.120). Overall treatment expenditure on immunosuppressive drugs, hospitalization, and treatment of infections was 1.57-fold higher in the MMF group (mean US $4635.9 compared with $2961.5 in the CTX-AZA group; p<0.001).


CONCLUSIONS
While the cost of MMF treatment for severe lupus nephritis is much higher compared with CTX-AZA, the increased drug cost is partially offset by savings from the reduced incidence of complications.
Tse
Kai Chung
KC
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.
Tang
Colin S O
CS
Lam
Man Fai
MF
Yap
Desmond Y H
DY
Chan
Tak Mao
TM
D000328:Adult; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D015994:Incidence; D007239:Infections / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000191:economics; D011014:Pneumonia / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid; D001379:Azathioprine