The Economic Burden of Post-transplant Events in Renal Transplant Recipients

Abstract

Kidney transplantation (KT) is considered the optimum treatment choice for end stage renal disease (ESRD) both from a clinical and economic perspective. The incidence of acute rejection (AR) from KD could differ according to different patient and donor characteristic, as well as, the type of immunosuppressant agent allocated. Thus, it is crucial to carefully examine the costs associated with the type of immunosuppressant agents as they directly affect the clinical outcomes of recipients. Tacrolimus which is one of the Calcineurin inhibitors (CI) have proven a huge success in kidney transplantation and are considered the cornerstone therapy post transplantation. Since the expiry of its patent in 2008, generic versions have been introduced in the market. While it has been widely accepted in the medical community to switch from brand to generic drug products provided that they have proven therapeutic bioequivalence, the switch has been documents to be sensitive case with particular products which are characterized by a narrow therapeutic index (NTI). Their concern is that most of the bioequivalence studies are conducted in health volunteers’ whom do not suffer any comorbidity which is not the case in real life settings. González et al., 2017 note that this conversion affected its dose and blood levels which lead to the occurrence of acute rejection episodes due to under immunosuppression and report that infectious adverse events occurred as a result of over immunosuppression. Another important observation that there was a post serum creatinine increase after the formulation conversion and also patients experienced greater incidence of magnesium wasting, and more episodes of rejection which led to greater institutional costs of care. These findings highlight that cost containment policies need to be revisited especially with NTI drugs as their extra monitoring costs might actually off-set the savings of the generic product in the short term.