While there is no Medicare time limit for dialysis patients, kidney transplant recipients lose their Medicare coverage 36 months after they receive their transplant. The loss of immunosuppressant drug coverage is associated with an increased risk of allograft failure.

Using a Markov model, we compared lifelong immunosuppressant drug coverage for adult kidney transplant recipients with the status quo from the perspective of the Medicare payer over a 20 year time horizon. A multivariable survival analysis of n=110269 adult kidney only transplant recipients under the age of 65 with allograft survival ≥ 36 months between January 2003 and October 2015 in United States Renal Data System was used to estimate incremental graft survival, for those with and without Medicare coverage. Costs were from the SRTR 2016 Annual Data Report and health utility estimates were acquired from the literature.

The allograft survival at 10 years after cessation of Medicare coverage was 60.4% compared to 52.5% in patients who continued to receive immunosuppressant drug coverage (p = <0.001). The predicted additional quality adjusted life years (QALYs) with life-long Medicare drug coverage was 0.63, and incremental costs of $58724; the incremental cost effectiveness ratio (ICER) was $93313 per QALY gained. This model was robust in a variety of one-way sensitivity analyses except for the cost of immunosuppression (ICER range: 30864-246845). In a threshold analysis, Medicare drug coverage was cost neutral if the annual immunosuppression payment was $1951 / patient / year for immunosuppression. The ICER was $50,000 per QALY gained if the cost of immunosuppression was $5192 dollars / year.

From a comprehensive health payer perspective, the incremental health care cost savings were $11539/person, and annual health care savings were $36 million if a policy of life long immunosuppressant drug was implemented for transplant recipients.

We conclude that Medicare provision of lifelong immunosuppression for kidney transplant recipients is cost-effective. Furthermore, this approach leads to greater health and lower net total health care costs.

CITATION INFORMATION: Kadatz M., Gill J., Gill J., Scott K. Cost Effectiveness of Lifelong Medicare Immunosuppressant Drug Coverage for Kidney Transplant Recipients in the Current Era Am J Transplant. 2017;17 (suppl 3).

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