title: Healthcare costs in renal transplant recipients using branded versus generic ciclosporin.
abstract: BACKGROUND
  Generic ciclosporin A modified (CsA) does not have an equivalent pharmacokinetic profile to branded CsA in some transplant populations, potentially leading to negative clinical consequences and increased long-term costs.
  
  
  OBJECTIVE
  To assess direct healthcare costs for de novo renal transplant recipients in the US receiving branded versus generic CsA in the first month after transplantation.
  
  
  METHODS
  Administrative claims data from eight private US health plans were linked to the Organ Procurement and Transplantation Network data. A total of 227 renal transplant cases between 1996 and 2004 were included: 183 were dispensed branded CsA and 44 received generic CsA. Log transformed multiple linear regression was used to model total first-year healthcare costs after the initial CsA claim, controlling for both patient demographics and clinical characteristics and clustering at the transplant centre level.
  
  
  RESULTS
  After controlling for patient factors and pre-CsA costs, total healthcare costs were significantly higher (p = 0.04) for patients receiving generic CsA versus branded CsA. The main driver for the difference was the cost associated with immunosuppressants other than CsA (p = 0.01).
  
  
  CONCLUSIONS
  Despite initial perceived cost savings associated with generic CsA, de novo renal transplant recipients incurred greater total healthcare costs than those treated with branded CsA. Patients receiving generic CsA may need higher doses or other immunosuppressants to maintain the transplanted kidney than patients receiving branded CsA. Providers and payers need to be aware of potential differences in total healthcare costs between formulations of bioequivalent critical-dose drugs to make the best choice for patient care.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: J Harold
authors.initials: JH
authors.lastname: Helderman
authors.forename: Ning
authors.initials: N
authors.lastname: Kang
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Legorreta
authors.forename: Judy Y
authors.initials: JY
authors.lastname: Chen
mesh_terms: D000328:Adult; D017046:Cost Savings / Q000379:methods; D016572:Cyclosporine / Q000191:economics* / Q000493:pharmacokinetics / Q000627:therapeutic use; D016568:Drugs, Generic / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D016030:Kidney Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D013810:Therapeutic Equivalency; D014481:United States
chemical_list: D016568:Drugs, Generic; D016572:Cyclosporine