An economic model of 2-hour post-dose ciclosporin monitoring in renal transplantation

PharmacoEconomics
P KeownZ Kaló

Abstract

Monitoring of microemulsion ciclosporin (cyclosporine; Neoral) by 2-hour post-dose drug concentrations (C2) is an accurate measure of ciclosporin absorption efficiency and exposure, and appears superior to trough (C0) monitoring for prediction of rejection risk. A predictive decision model was used to determine if this approach also reduces total treatment costs in the first 12 months after renal transplantation. Parameter estimates for key clinical events were derived from the literature and from prospective pharmacokinetic studies comprising 234 adult HLA-non-identical renal graft recipients at seven Canadian centres. Patients were treated with microemulsion ciclosporin (Neoral), corticosteroids and azathioprine or mycophenolate mofetil. Using the perspective of the Canadian healthcare provider, total treatment costs for the C2 versus the C0 strategy were modelled over 12 months, and then remodelled using conservative estimates to extend the timeframe to 5 years. Health resources were valued in 1999 Canadian dollars. The incidence of acute rejection was estimated to be 25% at 1 year in patients monitored by C0 and 18% in those monitored by C2. Patient survival was considered to be independent of monitoring strategy, and graft...Continue Reading

References

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Citations

Mar 26, 2004·Transplantation Proceedings·P A Keown
Aug 19, 2007·Kidney International·S DmitrienkoUNKNOWN Genome Canada Biomarkers in Transplantation Group
Nov 23, 2006·Transplantation Proceedings·C J FooteP Belitsky
Sep 16, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Bryce A Kiberd
Aug 21, 2007·Clinical Journal of the American Society of Nephrology : CJASN·Jeffrey SchiffMarcelo Cantarovich
Jul 14, 2011·Nature Reviews. Rheumatology·Michael SchirmerChristian Dejaco

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