A cost-effectiveness analysis was performed using data from a prospective single center trial where de novo kidney transplant recipients received a single 3 mg/kg dose of rabbit antithymocyte globulin, tacrolimus, everolimus and prednisone (r-ATG/EVR, n=85); basiliximab, tacrolimus, everolimus and prednisone (BAS/EVR, n=102) or basiliximab, tacrolimus, mycophenolate and prednisone (BAS/MPS, n=101). This analysis was developed from the perspective of the Public Healthcare System. The clinical outcomes considered for this analysis were: acute rejection, CMV viremia/disease, graft dysfunction, surgery complications, graft loss and death. The economic outcomes contemplated in the analyses were direct medical costs, including: immunosuppression, treatment of adverse events and follow-up of patients. To estimate costs and outcomes for each treatment a Markov model was used to follow patients during 12 months after transplantation.

Compared to the standard of care regimen, r-ATG/EVR and BAS/EVR were associated with 36% and 15% reduction in costs. This was primarily due to lower costs associated with the management of adverse events as there were no significant differences in the costs of immunosuppressive drugs. Compared to the standard of care regimen, r-ATG/EVR showed higher effectiveness in all clinical outcomes while BAS/EVR showed higher effectiveness for the prevention of CMV infection and graft loss and comparable effectiveness for the other clinical outcomes. A probabilistic sensitive analysis with 1000 simulations, using ±20% variation in costs and beta distributions for transition probabilities, efficacy and safety data, confirmed these observations.

Conclusion: In this cohort of de novo kidney transplant recipients receiving tacrolimus and prednisone and no CMV pharmacological prophylaxis, everolimus containing regimens were dominant (cost-effective) compared to the standard of care regimen.

CITATION INFORMATION: Tedesco-Silva H, Felipe C, Brigido A, Cristelli M, Paula M, Bessa A, Ruppel P, Medina-Pestana J. Reduced Incidence of Cytomegalovirus Infection in Kidney Transplant Recipients Receiving Everolimus: A Cost-Effectiveness Analyses. Am J Transplant. 2016;16 (suppl 3).

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