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Cost-minimization study comparing simulect versus thymoglobulin in renal transplant induction
Cost-Minimization Study Comparing Simulect Versus Thymoglobulin in Renal Transplant Induction H Lilliu, C Brun, C Le Pen, M Bu¨chler, A. Al Najjar, O Reigneau, and Y Lebranchu
B
ASED on the data of the clinical trial CHI-F-02 comparing efficacy and safety of basiliximab (Simulect®) versus antithymocyte globulin (Thymoglobulin) in renal transplantation induction, we carried out an economic evaluation.
MATERIALS AND METHOD This pharmacoeconomics study is a cost-minimization study, ie given the equivalent efficacy of the products, the strategy that minimizes the cost of care is considered as better or dominant. The cost of care is analyzed from the hospital perspective. The unit costs reflect the money spent by the hospital excluding logistic and structure expenses. The “piggy-back” study of 100 patients in the intention To Treat (ITT) population, estimated the direct medical costs incurred over six months of two strategies of renal transplant induction therapy: Simulect ⫹ Neoral ⫹ MMF ⫹ corticosteroids versus Thymoglobulin ⫹ Neoral ⫹ MMF ⫹ corticosteroids. Direct medical costs cover the medical resources consumed: medications, hospital stays, dialysis, consultations, and examinations not covered by the protocol. The costing method used the Diagnosis Related Group (DRG) and the hospitalization day cost from the analytic accounting of the Paris Group of Public Hospitals, Assistance Publique - Ho ˆpitaux de Paris (AP-HP). For the medications, the ex-factory prices of the drug are taking into account. Examinations and consultations are valorised according to the Nomenclature of medical activities, Nomenclature Ge´ne´rale des Actes Professionels (NGAP).
RESULTS
The study showed a significant reduction in initial hospital stay durations in the Simulect® arm, as well as a significant
reduction in the number of infectious episodes. Therefore, although the average cost of treatment with Simulect appears slightly higher than the cost with Thymoglobulin (2,964 versus 2,298 Euros), the cost of initial hospitalization is significantly lower in the Simulect arm (10,907 versus 11,967 Euros P ⫽.02) [Table 1]. Furthermore the mean cost of infections episodes is significantly lower in the Simulect arm 1,056 versus 1,790 Euros P ⫽ .03). CMV infection accounts for 30% of this cost in the Simulect arm and 53% in the Thymoglobulin arm with a significant different cost (P ⫽ .001) [Table 2]. CONCLUSION
In terms of direct medical costs, this study shows a saving of 1158 Euros per patient in the Simulect arm, which largely compensates the initial higher price of this immunosuppressor. The savings are due to fewer and less expensive infectious episodes in the Simulect® arm and shorter hospital duration. Given the fact that the efficacy of both strategies is comparable, Simulect® is a satisfying strategy with the same efficacy as that of Thymoglobulin with no supplementary cost from the hospital perspective.
CLP Sante´ (H.L.), Paris, Novartis-Pharma (C.B., O.R.), RueilMalmaison, Universite Paris Dauphine (C.L.P.), Pans, and CHRU Bretonneau (M.B., A.A.N., Y.L.), Tours, France. Address reprint requests to Dr L.H. Brun, 2-L Rue Lionel Terray, 92506 Rueil-Nalmaison, France.
Table 1. Direct Medical Cost per Patient (in FF) Simulect (n ⫽ 50)
Hospitalization transplant other causes outpatient clinics Medications immunosuppressive protocol and rejection
88,327 [75 649;101 004] 71,545* [60 950;82 141] 16,689 [7 804;25 573] 93 [0;231] 50,841 [46 677;55 006] 41,542* [38 289;44 797]
others Consultations and explorations Direct medical cost
9299 [6 206;12 391] 142 [45;239] 139,310 [126 109;152 512]
Thymoglobulin (n ⫽ 50)
95,470 [83 246;107 694] 78,500 [70 269;86 731] 16,723 [9 161;24 255] 247 [0;686] 51,355 [47 115;55 595] 39,142 [36 741;41 543] 9 12 213 [8 470;15 955] 83 [25;142] 146,908 [131 847;161 969]
*P ⬍ 0.05 Wilcoxon test. 1FF ⫽ 0.13 $US.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
0041-1345/01/$–see front matter PII S0041-1345(01)02360-0
Transplantation Proceedings, 33, 3197–3198 (2001)
3197
3198
LILLIU, BRUN, LE PEN ET AL Table 2. Cost of Infectious Episodes per Patient (FF)
Hospitalization for infectious episodes Medications including CMV treatments Consultations and explorations Total cost of infectious episodes *P ⬍ .05 Wilcoxon test. 1FF ⫽ 0.13 $US.
Simulect (n ⫽ 50)
Thymoglobulin (n ⫽ 50)
4246 [1 292;7 200] 2679* [573;4 784] 589* [75;1 102] 3 [0;9] 6928* [2369;11,487]
6507 [3 168;9 847] 5219 [2 494;7 944] 2519 [785;4 253] 18 [0;43] 11,744 [6607;16,881]
B
ASED on the data of the clinical trial CHI-F-02 comparing efficacy and safety of basiliximab (Simulect®) versus antithymocyte globulin (Thymoglobulin) in renal transplantation induction, we carried out an economic evaluation.
MATERIALS AND METHOD This pharmacoeconomics study is a cost-minimization study, ie given the equivalent efficacy of the products, the strategy that minimizes the cost of care is considered as better or dominant. The cost of care is analyzed from the hospital perspective. The unit costs reflect the money spent by the hospital excluding logistic and structure expenses. The “piggy-back” study of 100 patients in the intention To Treat (ITT) population, estimated the direct medical costs incurred over six months of two strategies of renal transplant induction therapy: Simulect ⫹ Neoral ⫹ MMF ⫹ corticosteroids versus Thymoglobulin ⫹ Neoral ⫹ MMF ⫹ corticosteroids. Direct medical costs cover the medical resources consumed: medications, hospital stays, dialysis, consultations, and examinations not covered by the protocol. The costing method used the Diagnosis Related Group (DRG) and the hospitalization day cost from the analytic accounting of the Paris Group of Public Hospitals, Assistance Publique - Ho ˆpitaux de Paris (AP-HP). For the medications, the ex-factory prices of the drug are taking into account. Examinations and consultations are valorised according to the Nomenclature of medical activities, Nomenclature Ge´ne´rale des Actes Professionels (NGAP).
RESULTS
The study showed a significant reduction in initial hospital stay durations in the Simulect® arm, as well as a significant
reduction in the number of infectious episodes. Therefore, although the average cost of treatment with Simulect appears slightly higher than the cost with Thymoglobulin (2,964 versus 2,298 Euros), the cost of initial hospitalization is significantly lower in the Simulect arm (10,907 versus 11,967 Euros P ⫽.02) [Table 1]. Furthermore the mean cost of infections episodes is significantly lower in the Simulect arm 1,056 versus 1,790 Euros P ⫽ .03). CMV infection accounts for 30% of this cost in the Simulect arm and 53% in the Thymoglobulin arm with a significant different cost (P ⫽ .001) [Table 2]. CONCLUSION
In terms of direct medical costs, this study shows a saving of 1158 Euros per patient in the Simulect arm, which largely compensates the initial higher price of this immunosuppressor. The savings are due to fewer and less expensive infectious episodes in the Simulect® arm and shorter hospital duration. Given the fact that the efficacy of both strategies is comparable, Simulect® is a satisfying strategy with the same efficacy as that of Thymoglobulin with no supplementary cost from the hospital perspective.
CLP Sante´ (H.L.), Paris, Novartis-Pharma (C.B., O.R.), RueilMalmaison, Universite Paris Dauphine (C.L.P.), Pans, and CHRU Bretonneau (M.B., A.A.N., Y.L.), Tours, France. Address reprint requests to Dr L.H. Brun, 2-L Rue Lionel Terray, 92506 Rueil-Nalmaison, France.
Table 1. Direct Medical Cost per Patient (in FF) Simulect (n ⫽ 50)
Hospitalization transplant other causes outpatient clinics Medications immunosuppressive protocol and rejection
88,327 [75 649;101 004] 71,545* [60 950;82 141] 16,689 [7 804;25 573] 93 [0;231] 50,841 [46 677;55 006] 41,542* [38 289;44 797]
others Consultations and explorations Direct medical cost
9299 [6 206;12 391] 142 [45;239] 139,310 [126 109;152 512]
Thymoglobulin (n ⫽ 50)
95,470 [83 246;107 694] 78,500 [70 269;86 731] 16,723 [9 161;24 255] 247 [0;686] 51,355 [47 115;55 595] 39,142 [36 741;41 543] 9 12 213 [8 470;15 955] 83 [25;142] 146,908 [131 847;161 969]
*P ⬍ 0.05 Wilcoxon test. 1FF ⫽ 0.13 $US.
© 2001 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010
0041-1345/01/$–see front matter PII S0041-1345(01)02360-0
Transplantation Proceedings, 33, 3197–3198 (2001)
3197
3198
LILLIU, BRUN, LE PEN ET AL Table 2. Cost of Infectious Episodes per Patient (FF)
Hospitalization for infectious episodes Medications including CMV treatments Consultations and explorations Total cost of infectious episodes *P ⬍ .05 Wilcoxon test. 1FF ⫽ 0.13 $US.
Simulect (n ⫽ 50)
Thymoglobulin (n ⫽ 50)
4246 [1 292;7 200] 2679* [573;4 784] 589* [75;1 102] 3 [0;9] 6928* [2369;11,487]
6507 [3 168;9 847] 5219 [2 494;7 944] 2519 [785;4 253] 18 [0;43] 11,744 [6607;16,881]