Alsaqa'aby Mai, Alissa Dema, Hussein Mohammed, Almudaiheem Hajar Y, Al-Jedai Ahmed
Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Therapeutic Affairs Deputyship, Ministry of Health, Riyadh, Saudi Arabia; Colleges of Medicine and Pharmacy, Al-Faisal University, Riyadh, Saudi Arabia.
Value Health Reg Issues. 2023 Jan;33:56-64. doi: 10.1016/j.vhri.2022.08.014. Epub 2022 Oct 13.
Chronic kidney disease is ranked fourth among the top 10 causes of death in Saudi Arabia. Renal transplantation has been recognized as the treatment of choice compared with long-term dialysis to maintain graft survival and prolong a patient's healthy living. Immunosuppressants (ISs) must be administered lifelong. The choice between IS therapies can be challenging because of the similarity in efficacy with some differences in adverse events profile. The objective of this study was to assess the cost-effectiveness of different IS regimens in Saudi Arabia.
A 25-year Markov model was developed based on a previously published study from the Saudi Ministry of Health payer perspective. Efficacy parameters were driven from the literature, whereas cost data were estimated from the Ministry of Health database. A Monte Carlo simulation was conducted to test the base-case model results' robustness.
All comparators resulted in 6.2 quality-adjusted life-years (QALYs) except for Advagraf® treatment (5.5 QALYs). Generic tacrolimus plus mycophenolate mofetil (MMF) will cost 70 701.45 US dollars ($) (Saudi riyal 265 130.44) per patient to gain 6.2 QALYs over 25 years' time horizon. In the improved adherence scenario, Envarsus® plus generic MMF generated 9.6 QALYs with a cost of $59 849 per patient. Monte Carlo simulation results have shown that generic tacrolimus is still the cheapest treatment option compared with other treatment arms.
The current analysis suggested that all IS options are not cost-effective strategies relative to the willingness-to-pay threshold of $20 000. Nevertheless, Envarsus plus generic MMF regimen could become the most cost-effective regimen at different willingness-to-pay thresholds.
在沙特阿拉伯，慢性肾脏病在十大死因中位列第四。与长期透析相比，肾移植已被公认为是维持移植物存活和延长患者健康寿命的首选治疗方法。免疫抑制剂必须终身服用。由于疗效相似但不良事件特征存在一些差异，免疫抑制剂治疗方案的选择可能具有挑战性。本研究的目的是评估沙特阿拉伯不同免疫抑制剂方案的成本效益。
基于沙特卫生部付款人的视角，根据先前发表的一项研究建立了一个25年的马尔可夫模型。疗效参数来自文献，而成本数据则根据卫生部数据库估算。进行了蒙特卡洛模拟以检验基础模型结果的稳健性。
除Advagraf®治疗（5.5个质量调整生命年）外，所有比较方案均产生6.2个质量调整生命年。在25年的时间范围内，普通他克莫司加霉酚酸酯（MMF）每位患者将花费70701.45美元（沙特里亚尔265130.44）以获得6.2个质量调整生命年。在改善依从性的情况下，Envarsus®加普通MMF产生9.6个质量调整生命年，每位患者成本为59849美元。蒙特卡洛模拟结果表明，与其他治疗组相比，普通他克莫司仍然是最便宜的治疗选择。
当前分析表明，相对于20000美元的支付意愿阈值，所有免疫抑制剂方案都不是具有成本效益的策略。尽管如此，Envarsus加普通MMF方案在不同的支付意愿阈值下可能成为最具成本效益的方案。
