A UK analysis of the cost of switching renal transplant patients from an immediate-release to a prolonged-release formulation of tacrolimus based on differences in trough concentration variability

Figures & data

Figure 1. Graft and patient survival from the National Health Service Blood and Transplant 2011–2012 Organ Donation and Transplantation Activity Report18. Data at years 3 and 4 were linearly interpolated using values from years 2 and 5.

Table 1. Costs used in the base case analysis.

Cost item	Cost	Reference
PR tacrolimus (GBP per mg)	1.43	BNF
IR tacrolimus (GBP per mg)	1.61	BNF
Mycophenolatemofetil (GBP per mg)	0.00126	BNF
Corticosteroids (GBP per mg)	0.164	BNF
Acute rejection episode (GBP)	28.5	BNF
Treatment-refractory acute rejection episode (GBP)	6701.65	BNF
Peritoneal dialysis (GBP per day)	53.00	NHS National Tariff (HRG LD12A)
Hemodialysis (GBP per session)	123.00	NHS National Tariff (HRG LD01A)

BNF, British National Formulary; GBP, Pounds Sterling; HRG, Healthcare Resource Group; NHS, National Health Service.

Table 2. Base case results expressed as per-patient costs over a 5-year time horizon.

	PR tacrolimus (GBP)	IR tacrolimus (GBP)	Difference (GBP)
Cost of tacrolimus treatment	12,871 ± 2718	14,430 ± 3043	−1558 ± 516
Cost of concomitant medications	4162 ± 544	4162 ± 544	0 ± 0
Costs of dialysis	9783 ± 8	11,640 ± 9	−1856 ± 1
Cost of acute rejection	125 ± 0	125 ± 0	0 ± 0
Total	26,941 ± 2765	30,356 ± 3085	−3415 ± 516

Results are presented as mean ± standard deviation.

Figure 2. Incremental cost of PR tacrolimus vs IR tacrolimus over a range of relative risks of graft failure with high tacrolimus trough concentration variability.

Table 3. One-way sensitivity analysis results.

	PR tacrolimus (GBP)	IR tacrolimus (GBP)	Difference (GBP)
Base case	26,941 ± 2765	30,356 ± 3085	−3415 ± 516
3-year time horizon	15,804 ± 1671	17,696 ± 1871	−1893 ± 314
3.5% discount rate	25,209 ± 2552	28,399 ± 2853	−3190 ± 482
With re-transplantation	24,330 ± 2771	27,258 ± 3095	−2928 ± 521
No difference in proportion of patients with high variability	28,826 ± 2799	30,356 ± 3085	−1530 ± 520
No increase in graft failure risk with high variability	26,569 ± 2786	28,132 ± 3105	−1563 ± 513
No difference in the cost of PR tacrolimus and IR tacrolimus	28,486 ± 3083	30,356 ± 3085	−1870 ± 420

RR, relative risk.

Results are presented as mean ± standard deviation.

NHS Blood and Transplant. Transplant Activity in the UK. Activity report 2011–12. Watford, UK. 2012. http://www.organdonation.nhs.uk/statistics/transplant_activity_report/current_activity_reports/ukt/activity_report_2011_12.pdf. Accessed June 4, 2013

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