Budget impact of switching from an immediate-release to a prolonged-release formulation of tacrolimus in renal transplant recipients in the UK based on differences in adherence

Figures & data

Figure 1 Graft and patient survival from the National Health Service Blood and Transplant 2011–2012 organ-donation and transplantation-activity report.¹⁶

Note: 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 (£/mg)	Reference
Advagraf	1.43	BNF^Citation22
Prograf	1.61	BNF^Citation23
Adoport (generic tacrolimus)	1.31	BNF^Citation24
Mycophenolate mofetil	0.00126	BNF^Citation25
Corticosteroids	0.164	BNF^Citation26
Cost item	Cost	Reference
Acute rejection episode (£)	28.5	BNF^Citation27
Treatment-refractory acute rejection episode (£)	6,701.65	BNF^Citation28
Peritoneal dialysis (£/day)	53.00	NHS National Tariff (HRG LD12A)^Citation29
Hemodialysis (£/session)	123.00	NHS National Tariff (HRG LD01A)^Citation29

Abbreviations: BNF, British National Formulary; HRG, Healthcare Resource Group; NHS, National Health Service.

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

	Advagraf (£)	Prograf (£)	Difference (£)
Cost of tacrolimus treatment	12,910±2,767	14,467±3,098	−1,557±519
Cost of concomitant medications	4,182±543	4,182±543	0±0
Cost of dialysis	12,112±119	14,288±213	−2,176±94
Cost of acute rejection	125±0	125±0	0±0
Total	29,328±2,844	33,061±3,178	−3,733±530

Note: Results presented as means ± standard deviation.

Table 3 One-way sensitivity-analysis results

	Advagraf (£)	Prograf (£)	Difference (£)
Base case	29,328±2,844	33,061±3,178	−3,733±530
3-year time horizon	17,054±1,679	19,119±1,871	−2,065±311
3.5% discount rate	27,463±2,552	30,949±2,864	−3,485±496
With retransplantation	26,041±2,663	29,200±2,994	−3,159±523
No difference in graft failure RR with nonadherence	26,640±2,722	28,222±3,043	−1,582±522
“Fair” adherence RR from Pinsky et al^Citation13	27,080±2,944	29,174±3,270	−2,094±520
“Poor” adherence RR from Pinsky et al^Citation13	27,472±2,752	29,757±3,077	−2,285±515
Graft failure RR from Sellarés et al^Citation28	31,021±2,766	36,227±3,114	−5,207±535
No difference in cost of Advagraf and Prograf	30,860±3,081	33,061±3,178	−2,201±432
Prograf cost-equivalence with Adoport	29,328±2,844	30,372±2,552	−1,044 (440)

Note: Results presented as mean ± standard deviation.

Abbreviation: RR, relative risk.

Figure 2 Incremental cost of Advagraf relative to Prograf over a range of relative risks of graft failure with poor adherence.

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