Abstract
To date, population-based studies on the healthcare service utilization among stable heart, kidney, and liver transplant recipients with different calcineurin inhibitors are still scarce. Therefore, we used the Taiwan National Health Insurance Research Database to conduct a nationwide cross-sectional study to estimate the healthcare utilization of stable transplant recipients with tacrolimus or cyclosporine (n = 3,482). The sampled patients in this study comprised 377 heart, 1,693 kidney, and 1,412 liver transplant recipients between 1 January 2011 and 31 December 2011. Each subject was followed for a 1-year period to evaluate his/her healthcare service utilization. Outcome variables of the healthcare service utilization were stated as below: numbers of outpatient visits, outpatient costs, numbers of inpatient days, inpatients costs, and total costs of all healthcare services. As for all healthcare service utilization, stable transplant recipients on tacrolimus had significantly more outpatient visits (40.7 vs. 38.6), outpatient costs (US$10,383 vs. US$8,155), and total costs (US$12,516 vs. US$10,372) of all healthcare services than those on cyclosporine during the 1-year follow-up period. Additionally, further analysis showed that heart transplant recipients receiving tacrolimus incurred 1.7-fold higher inpatient costs compared to patients receiving cyclosporine. We concluded that transplant recipients using tacrolimus had significantly higher utilization of all healthcare services than those receiving cyclosporine as immunosuppressive therapy.
Highlights
Solid organ transplantation is expensive and exerts a huge financial burden on transplant recipients
Other findings revealed that the distributions of sex, hypertension, hyperlipidemia, coronary heart disease, arrhythmia, thyroid disease, anxiety, and transplanted organ were significantly different between tacrolimus and cyclosporine users
Regarding all healthcare services, tacrolimus users had higher total costs (US$12,227 vs. US$9,384), study drug costs (US$3,415 vs. US$2,079), and other costs (US$8,812 vs. US$7,304) than cyclosporine users. This population-based study found that stable transplant recipients receiving tacrolimus had higher healthcare service utilization, including outpatient visits, outpatient costs, and total costs of all NHI healthcare services, than transplant recipients receiving cyclosporine (Table 2)
Summary
Solid organ transplantation is expensive and exerts a huge financial burden on transplant recipients. In the early 1980s, cyclosporine, a calcineurin inhibitor, was introduced in the market and provided excellent renal graft survival rates (Starzl et al, 1980; Gjertson et al, 1995). This agent impairs the transcription of interleukin-2 and several other cytokines in T lymphocytes (Jasiak and Park, 2016). Since its Food and Drug Administration (FDA) approval in the early 1990s, tacrolimus has been widely used as an alternative immunosuppressive medication after all types of solid organ transplants; it is a more potent calcineurin inhibitor. Tacrolimus may plausibly result in additional costs of managing adverse events and increase the non-transplant-related health service utilization of transplant recipients
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