Gardiner Kyle M, Tett Susan E, Staatz Christine E
School of Pharmacy, University of Queensland, Brisbane, QLD, Australia.
Ann Transplant. 2016 Jan 5;21:1-11. doi: 10.12659/aot.895664.
Increasing immunosuppressant utilization and expenditure is a worldwide challenge as more people successfully live with transplanted organs. Our aims were to characterize utilization of mycophenolate, tacrolimus, cyclosporin, sirolimus, and everolimus in Australian transplant recipients from 2007 to 2013; to identify specific patterns of usage; and to compare Australian utilization with Norwegian, Danish, Swedish, and the Netherlands use.
Australian utilization and expenditure data were captured through national Pharmaceutical Benefits Scheme and Highly Specialized Drug administrative databases. Norwegian, Danish, Swedish, and the Netherlands utilization were retrieved from their healthcare databases. Utilization was compared as defined daily dose per 1000 population per day (DDD/1000 population/day). Data on kidney transplant recipients, the predominant patient group prescribed these medicines, were obtained from international transplant registries.
From 2007-2013 Australian utilization of mycophenolic acid, tacrolimus and everolimus increased 2.7-fold, 2.2-fold, and 2.3-fold, respectively. Use of cyclosporin and sirolimus decreased 20% and 30%, respectively. Australian utilization was significantly lower than European utilization (2013) but was increasing at a faster rate. Total Australian expenditure increased approximately AUD$30 million over the study period to almost AUD$100 million in 2013. Kidney transplantation rates increased across each country over this time, with Australia having the lowest rate.
Immunosuppressant usage and subsequent expenditure are rising in Australia and Northern Europe. With increased numbers of people living with transplants, and the observed growth potential predicted from Northern European data, this class of medicines can be expected to continue consuming an increasing share of Australian pharmaceutical expenditure into the future.
随着越来越多的人成功依靠移植器官生存，免疫抑制剂使用量和费用的增加成为一个全球性挑战。我们的目的是描述2007年至2013年澳大利亚移植受者中霉酚酸酯、他克莫司、环孢素、西罗莫司和依维莫司的使用情况；确定具体的使用模式；并将澳大利亚的使用情况与挪威、丹麦、瑞典和荷兰的使用情况进行比较。
澳大利亚的使用和费用数据通过国家药品福利计划和高度专业化药品管理数据库获取。挪威、丹麦、瑞典和荷兰的使用情况从其医疗保健数据库中检索。使用情况按每1000人口每天的限定日剂量（DDD/1000人口/天）进行比较。肾移植受者的数据，即开具这些药物的主要患者群体的数据，从国际移植登记处获得。
2007年至2013年，澳大利亚霉酚酸、他克莫司和依维莫司的使用量分别增加了2.7倍、2.2倍和2.3倍。环孢素和西罗莫司的使用量分别下降了20%和30%。澳大利亚的使用量明显低于欧洲（2013年），但增长速度更快。在研究期间，澳大利亚的总支出增加了约3000万澳元，到2013年几乎达到1亿澳元。在此期间，每个国家的肾移植率都有所上升，澳大利亚的肾移植率最低。
澳大利亚和北欧的免疫抑制剂使用量及后续费用都在上升。随着移植生存人数的增加，以及从北欧数据预测的增长潜力，预计这类药物在未来将继续占据澳大利亚药品支出中越来越大的份额。
