Treatment Patterns, Healthcare Resource Utilization, and Costs in Kidney Transplant Recipients Using a Fixed Source Regimen of Tacrolimus Vs. a Variable Source Regimen
1Astellas Scientific and Medical Affairs, Northbrook, IL
2Comprehensive Health Insights, Humana, Louisville, KY
3Humana, Louisville, KY.
Meeting: 2015 American Transplant Congress
Abstract number: A231
Keywords: Immunosuppression, Kidney transplantation
Session Information
Session Name: Poster Session A: Non Organ Specific, Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background
Tacrolimus (TAC) has evolved to be the foundation of kidney transplant immunosuppressant protocols. However, the implications of switching between multiple formulations of TAC have not been extensively researched.
Objective
To examine healthcare resource utilization (HRU) and costs among kidney transplant members on a fixed source (FS) regimen of TAC versus those whose manufacturer changes within an existing TAC dose, variable source (VS).
Methods
This study was a cross-sectional, retrospective analysis of administrative claims data from a large managed care organization. Kidney transplant members on TAC for the representative 2013 calendar year were identified and categorized as FS or VS. The FS group included members with TAC regimens from a consistent manufacturer. The VS group included those changing manufacturers within an existing TAC dose. HRU and costs were examined and compared between the groups.
Results
A total of 1,024 members were identified with TAC utilization during 2013 (FS: n=674, 66%; VS: n=350, 34%). In the VS group, the mean (SD) number of days from formulation switch to outpatient visit was 23.8 (33.6), while the number of days elapsed to performance of a TAC lab test was 43.6 (56.2). VS members had a higher proportion of ER utilization (45% v 35%, P<0.01) and more TAC monitoring events (8.13 v 7.01, P=0.03) compared to FS. Significant differences in the frequency of inpatient or outpatient utilization were not observed.
Likewise, mean unadjusted total healthcare costs (HCC) were not significantly different between VS and FS ($33,470 v $34,071, P=0.851), but tacrolimus medication costs were significantly lower in VS ($3,135 v $3,629, P=0.007). However, in an adjusted analysis controlling for patient and plan characteristics, adjusted total HCC were 9% lower for VS compared to FS ($28,054 v $30,823, P=0.045).
Conclusion
Despite having greater HRU in some areas, VS had slightly lower overall costs. However, the clinical consequences associated with an extended lapse in time to a follow up TAC lab after a manufacturer switch should be considered. Additionally, concerns over bioequivalence among generic formulations may exist, as indicated by greater TAC monitoring in the VS group.
To cite this abstract in AMA style:
Lee E, Bunniran S, Kamble P, Suehs B, Franks B, Schwartz J, Anderson C, Thal G, Spalding J. Treatment Patterns, Healthcare Resource Utilization, and Costs in Kidney Transplant Recipients Using a Fixed Source Regimen of Tacrolimus Vs. a Variable Source Regimen [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/treatment-patterns-healthcare-resource-utilization-and-costs-in-kidney-transplant-recipients-using-a-fixed-source-regimen-of-tacrolimus-vs-a-variable-source-regimen/. Accessed May 12, 2025.« Back to 2015 American Transplant Congress