THE COST-EFFECTIVENESS OF MYCOPHENOLATE MOFETIL IN THE FIRST YEAR AFTER PRIMARY CADAVERIC TRANSPLANT

Mycophenolate mofetil (MMF) has been shown to reduce the incidence of acute graft rejection in three controlled trials of cadaveric renal tr ansplantation. In a U.S. trial using quadruple sequential induction th erapy as control, the MMF 2-g treatment group had an acute rejection r ate 40.6% lower than control in the first posttransplant year (27.9% M MF-treated versus 47.0% control). The purpose of this analysis is to e valuate the economic implications of these clinical differences. The a nalysis relies on resource use data from the trial and other sources. Medical costs were estimated using a societal perspective and excluded the cost of the transplant procedure and organ acquisition. The two g roups were compared in terms of treatment for acute rejection and oppo rtunistic infection, graft survival, dialysis use, and maintenance imm unosuppression. The results suggest that, on average, when compared wi th standard therapy, patients treated with MMF are likely to have lowe r rejection-related treatment costs because of a lower incidence of re jection ($6237 versus $3702), lower dialysis and graft failure costs b ecause of improved graft survival ($20,104 vel sus $16,972), no differ ence in opportunistic infection treatment costs ($1962 versus $1962), and higher additional immunosuppression costs ($855 versus $5170). Tak en together, these results suggest that patients treated with MMF are, on average, likely to have slightly lower first-year costs ($29,158 v ersus $27,807) compared with control, indicating that MMF treatment is cost-effective in the first year. These results remained stable under sensitivity analyses, with plausible variation in the rates of acute rejection, graft survival, and infection.