SURVEY OF CYCLOSPORINE-SPARING AGENT USE IN AUSTRALASIAN TRANSPLANT CENTERS

Background: The coprescription of drugs which elevate cyclosporin bloo d concentration has been advocated to reduce the costs associated with use of this expensive immunosuppressive drug. This is the first time that drugs have been widely prescribed for an economic purpose and whi le it is thought to be widespread, there are little published data on the extent of this practice in Australia and New Zealand. Aims: To det ermine the extent to which cyclosporin sparing agents are used by Aust ralian and New Zealand organ transplant centres, to determine which ag ents are used and why these agents are used by some but not all centre s. Methods: Organ transplant centres were surveyed via a questionnaire . Results: Considerable variation in use of cyclosporin sparing agents exists both within and across organ transplant types by Australian an d New Zealand transplant centres. Diltiazem use is more widespread tha n ketoconazole. Conclusions: Little of the variability in use of cyclo sporin sparing agents can be explained by scientific considerations. W hile the central government benefits from the significant cost savings achieved by the use of cyclosporin sparing agents, individual transpl ant units may not. Transplant units may however be the major target in the event of litigation arising as a result of adverse effects. The a vailability of generic brands and improved formulations of cyclosporin may affect the viability of using cyclosporin sparing agents.