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首页> 外文期刊>Patient Preference and Adherence >Cost utility analysis of immunosuppressive regimens in adult renal transplant recipients in?England and Wales
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Cost utility analysis of immunosuppressive regimens in adult renal transplant recipients in?England and Wales

机译：英格兰和威尔士成年肾移植受者免疫抑制方案的成本效用分析

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Background: End-stage renal disease is the irreversible final stage of chronic kidney disease and is fatal when not managed by either transplantation or dialysis. Transplantation is generally preferred over dialysis. However, to prevent graft rejection or loss, lifelong immunosuppression is required. Tacrolimus is currently the cornerstone of post-transplantation immunosuppression. The study aim was to carry out an economic evaluation of immunosuppression, including more recent agents such as a once-daily prolonged-release formulation of tacrolimus (Advagraf?) and belatacept, relative to a twice-daily immediate-release formulation of tacrolimus (Prograf?).Methods: A model was constructed comprising six states: onset of biopsy-confirmed acute rejection, functioning graft with or without a biopsy-confirmed acute rejection, non-functioning graft (dialysis), re-transplantation, and death. Data on clinical effectiveness were derived from a systematic literature review and the model captured the effects of patient adherence to immunosuppressant therapy on graft survival using relative risk of graft survival and published data on adherence in patients using Advagraf and Prograf. In the base case, the time horizon was 25?years and one-way and probabilistic sensitivity analyses were conducted.Results: The analysis demonstrated that Prograf was cost-effective when compared with cyclosporin and belatacept and was more effective than sirolimus, but would not be considered cost-effective against sirolimus. The modeled improvement in the adherence profile of patients using Advagraf relative to Prograf resulted in both improved clinical outcomes and reduced costs. Conclusion: Prograf was more clinically effective than cyclosporin, belatacept, and sirolimus, supporting its current positioning as the mainstay of immunosuppressive therapy in renal transplant recipients. Based on improved patient adherence with Advagraf, the model projected that Advagraf would be both more effective and less costly than Prograf. Replacing Prograf with Advagraf as the standard of care for post-transplant immunosuppression could likely result in both cost savings and improved clinical outcomes.
机译：背景：终末期肾脏疾病是慢性肾脏病不可逆转的最后阶段，如果不通过移植或透析进行治疗，将会致命。移植通常优于透析。但是，为了防止移植物排斥或丢失，需要终身免疫抑制。他克莫司目前是移植后免疫抑制的基石。该研究的目的是对免疫抑制进行经济评估，包括相对于每日两次的他克莫司即时释放制剂（Prograf）而言，他克莫司（Advagraf？）和belatacept的每日一次延长释放制剂。方法：构建包括六个状态的模型：活检确认的急性排斥反应的发作，有或没有活检确认的急性排斥反应的功能性移植物，无功能的移植物（透析），再移植和死亡。关于临床有效性的数据来​​自系统的文献综述，该模型利用移植物存活的相对风险捕获了患者对免疫抑制剂治疗的依从性对移植物存活的影响，并使用Advagraf和Prograf公布了患者依从性的数据。在基本情况下，时间跨度为25年，并进行了单向和概率敏感性分析。结果：分析表明，与环孢菌素和贝拉西普相比，Prograf具有成本效益，并且比西罗莫司更有效，但不会被认为对西罗莫司具有成本效益。与Adgraf相比，使用Advagraf的患者依从性方面的模型化改进既改善了临床效果又降低了成本。结论：Prograf在临床上比环孢菌素，贝拉西普和西罗莫司更有效，支持其目前作为肾移植受者免疫抑制治疗的主要手段。基于改善患者对Advagraf的依从性，该模型预测Advagraf将比Prograf更加有效且成本更低。用Advagraf代替Prograf作为移植后免疫抑制的标准治疗方法可能会节省成本并改善临床效果。

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