Cost-effectiveness analysis of the use of mTOR signaling pathway inhibitors x mycophenolate in kidney transplantation recipients without cytomegalovirus prophylaxis

Abstract

Objective: Evaluate the cost-effectiveness of immunosuppressive regimens used in kidney transplant recipients at the Santa Casa de Misericórdia, Hospital in Juiz de Fora, MG, compared with basiliximab, mycophenolate sodium, tacrolimus and prednisone (Group 1 = 93 patients) with the association of thymoglobulin, everolimus, tacrolimus and prednisone (Group 2 = 91 patients). Methods: For the pharmacoeconomic analysis, the Decision Tree model was used, developed in the TreeAge Suite 2011 software. A real cohort of patients undergoing kidney transplantation between January 2013 and March 2017 was considered, they were followed up for a period of 1 year, where the clinical benefits were measured, as well as the associated costs, from the perspective of the Unified Health System. The costing method used was the botton-up. Cost-effectiveness thresholds equivalent to 1 PIB per capita and 1 to 3 PIB were adopted, considering the year 2017. Results: Regard to survival, the ICER was R$ 214,234.12 for 1 year of life gained. Regarding adverse events, the ICER was R$ 43,682.98 for 1 year with no incidence of adverse events. Conclusions: Evaluating survival and incidence of adverse events, thymoglobulin+everolimus is not considered cost-effective in relation to the regimen containing basiliximab+mycophenolate sodium in the face of an cost-effectiveness threshold of 1 PIB per capita. However, when adopting threshold up to 3 GDP per capita, the regimen containing thymoglobulin+everolimus is cost-effective, exceeding about 38% PIB per capita.