title: Cost and efficacy of immunosuppression using generic products following living donor liver transplantation in India.
abstract: BACKGROUND
  Cost of post liver transplant immunosuppression is a major financial burden to patients in developing countries. In India, generic varieties of various immunosuppressants are often used without any definite evidence to their efficacy. This study was aimed at studying the dosage, side effect profile and cost of post-liver transplant immunosuppression using generic products in Indian population following living donor liver transplantation (LDLT).
  
  
  METHODS
  Data on dose, cost, and toxicity of immunosuppression were retrieved retrospectively from case records of 59 patients who had undergone LDLT at our center.
  
  
  RESULTS
  Adequate immunosuppression was obtained by tacrolimus (Pangraf(®)-Panacea) of 0.04 to 0.05 mg/Kg, and mycophenolate (Mycept(®)-Panacea) of 500 to 1,000 mg; the acute rejection rate was 15% during the first month. Serum tacrolimus levels were 5.4 to 7.3 ng/mL. The cost of immunosuppression varied from Rs. 28,705 in the first month to Rs. 8,820 per month at the end of first year, amounting to an average monthly cost of Rs. 17,250. Approximately 23% and 51% of cost was for mycophenolate and for drug level measurement of tacrolimus, respectively.
  
  
  CONCLUSIONS
  Average cost of immunosuppression after LDLT in India is much lower than that reported elsewhere in the world, since lower drug doses are needed and cheaper generic drugs are available. This can be reduced further by decreasing the frequency of tacrolimus drug level measurement.
authors.affiliation: Amrita Institute of Medical Sciences, Elamakkara PO, Kochi, 682 026 Kerala, India. sudhisalini@vsnl.net
authors.forename: S
authors.initials: S
authors.lastname: Sudhindran
authors.forename: Shameena
authors.initials: S
authors.lastname: Aboobacker
authors.forename: Ramachanndran N
authors.initials: RN
authors.lastname: Menon
authors.forename: G
authors.initials: G
authors.lastname: Unnikrishnan
authors.forename: O V
authors.initials: OV
authors.lastname: Sudheer
authors.forename: Puneet
authors.initials: P
authors.lastname: Dhar
mesh_terms: D017048:Health Care Costs; D006801:Humans; D007165:Immunosuppression Therapy / Q000191:economics*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D007194:India; D008107:Liver Diseases / Q000191:economics / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics*; D019520:Living Donors; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000191:economics; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus