title: Cost-effectiveness analysis of the early conversion of tacrolimus to mammalian target of rapamycin inhibitors in patients with renal transplantation.
abstract: BACKGROUND
  Renal replacement therapies which consist of renal transplantation and dialysis are the only treatment options for patients with terminal renal failure. These therapies have changed the outcome from being fatal to being a chronic disease. Kidney transplantation involves the use of immunosuppressive agents to prevent rejection. Currently, several immunosuppressive agents have shown efficacy, safety, and different costs.
  
  
  OBJECTIVE
  The aim was to evaluate the cost-effectiveness of early conversion from tacrolimus to mammalian target of rapamycin inhibitors sirolimus or everolimus versus continuous treatment with tacrolimus among renal transplantat patients in Colombia.
  
  
  METHODS
  We performed systematic literature review to extract data for clinical effectiveness and safety of tacrolimus replacement schemes for immunosuppressive therapy in renal transplantation in adults. A Markov model in TreeAge was developed, simulating the patient's natural history with renal transplantation. The perspective of the Colombian Health System was used, including only direct costs. The cost-effectiveness ratio and incremental cost-effectiveness ratio were estimated. Deterministic and probabilistic sensitivity analyses were performed. A 5% discount rate was applied in costs and health results.
  
  
  RESULTS
  Results for the replacement of tacrolimus to sirolimus are provided. The cost per year of additional life gained for sirolimus was Col$2,441,171.43; the cost for avoided loss was Col$4,014,152.84. The acceptability curve shows that a strategy with sirolimus is the most cost-effective one.
  
  
  CONCLUSIONS
  This study suggested that the sirolimus strategy is cost-effective in Colombia for patients with renal transplantation using as threshold less than three times the gross domestic product (GDP) per capita of Colombia per life of years gained.
authors.affiliation: Fundación Esensa, Bogotá, Colombia. oa_gamboa@yahoo.es
authors.forename: O
authors.initials: O
authors.lastname: Gamboa
authors.forename: C
authors.initials: C
authors.lastname: Montero
authors.forename: L
authors.initials: L
authors.lastname: Mesa
authors.forename: C
authors.initials: C
authors.lastname: Benavides
authors.forename: A
authors.initials: A
authors.lastname: Reino
authors.forename: R E
authors.initials: RE
authors.lastname: Torres
authors.forename: J S
authors.initials: JS
authors.lastname: Castillo
mesh_terms: D002986:Clinical Trials as Topic; D003105:Colombia; D003362:Cost-Benefit Analysis; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000379:methods*; D008390:Markov Chains; D012042:Registries; D051437:Renal Insufficiency / Q000628:therapy*; D020123:Sirolimus / Q000037:antagonists & inhibitors*; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus