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NDT Advance Access originally published online on April 17, 2009
Nephrology Dialysis Transplantation 2009 24(7):2258-2269; doi:10.1093/ndt/gfp174
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The cost-effectiveness of induction immunosuppression in kidney transplantation

Rachael L. Morton1, Kirsten Howard1, Angela C. Webster1,2, Germaine Wong2 and Jonathan C. Craig1,2

1 School of Public Health, The University of Sydney, Sydney, NSW, 2006 2 Centre for Kidney Research, The Children's Hospital Westmead, Westmead, 2145, NSW, Australia

Correspondence and offprint requests to: Rachael Morton; E-mail: rachaelm{at}health.usyd.edu.au



  Abstract

Background. Induction immunosuppression is perceived as an expensive therapy, so is often given only to select patients. This study evaluated the cost-effectiveness of antibody induction comparing interleukin-2 receptor antagonists (IL2Ra) to standard therapy with no induction or induction with polyclonal antibodies.

Methods. A Markov model was developed to estimate costs and health outcomes [survival (life years saved, LYS) and quality-adjusted survival (QALYs)] for the alternative strategies. Outcome data were obtained from a meta-analysis of randomized trials and large-scale renal registries.

Results. IL2Ra offers improved survival of 0.21 LYS (2.5 months) and 1.42 QALYs compared with no induction, with a cost saving over 20 years of $79 302 per patient treated regardless of risk profile. The incremental benefits of IL2Ra compared with polyclonal antibody induction therapy were 0.35 LYS (4.3 months) and 0.20 QALYs, with an incremental cost of $5144 per patient. The incremental cost-effectiveness ratio (ICER) of IL2Ra compared to polyclonal induction was $14 803 per LYS and $25 928 per QALY. Sensitivity analyses showed that IL2Ra remained more effective and less expensive than no induction. When IL2Ra was compared to polyclonal induction, the model was sensitive to changes in the cost of induction and the probability of malignancy. Over the range of all other variables tested, IL2Ra was cost-effective compared to polyclonal induction.

Conclusions. Adopting IL2Ra as induction immunosuppression for kidney transplant recipients improves survival and QALYs and is less costly than no induction. It also represents good value for money compared to polyclonal induction.

Keywords: cost-effectiveness; immunosuppression; kidney transplant; QALYs

Received for publication: 16.12.08
Accepted in revised form: 1. 3.09


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