PCV20 Cost-Effectiveness of a Tacrolimus-Mycophenolate Mofetil Regimen for Organ Rejection Prophylaxis in Heart Transplant Recipients in Colombia

Abstract

Evidence of the cost-effectiveness of the calcineurin inhibitor tacrolimus is required to guide its inclusion in the Colombian National Benefit Plan as a treatment for organ rejection prophylaxis in heart transplant recipients. A model was developed to estimate the cost-effectiveness of tacrolimus-mycophenolate mofetil (TAC-MMF) versus cyclosporine-mycophenolate mofetil (CYC-MMF) for organ rejection prophylaxis in heart transplant recipients in Colombia. A Markov model with monthly cycle length was constructed to estimate costs and quality-adjusted life years (QALY) for each treatment alternative over a 15-year time horizon from the perspective of the Colombian third-party payer. The following states were considered: alive with a functioning graft, history of acute graft rejection, cardiac allograft vasculopathy, and death. The costs were estimated using the Social Security (Instituto del Seguro Social) Rates Manual and reports of the Medicine Price Information System, and the resources and cost-generating events were identified using a base case constructed with clinical experts. The rejection rate for each treatment alternative was taken from a previously undertaken meta-analysis. Information on vasculopathy and mortality was taken from observational studies with follow-up times beyond 1 month, and was later adjusted to probabilistic distributions to obtain a monthly probability of developing the outcome. The TAC-MMF regimen represented a 0.236 difference in QALY and a cost difference of US −$18,337 versus CYC-MMF over the 15-year time horizon (US $1 = Colombian peso ∼3763, November 2020), which makes the former a dominant intervention. The main differentiators of the treatment alternatives in the model were acute rejection rate, cardiac allograft vasculopathy, and treatment cost. In this regard, the cost of CYC treatment was higher than the cost of TAC treatment. Under the model assumptions, the TAC-MMF regimen could be a dominant option over the CYC-MMF regimen for organ rejection prophylaxis in heart transplant recipients in Colombia.