A PHARMACOECONOMIC ANALYSIS OF NEORAL WITHOUT INTRAVENOUS CYCLOSPORINE IN LIVER-TRANSPLANTATION IN CANADA

Neoral, a microemulsion formulation of cyclosporin A (CsA), has improv ed absorption compared to Sandimmune and has allowed induction of immu nosuppression in liver transplantation (LT) without the use of intrave nous (IV) CsA. The improved bioavailability with less inter- and intra -patient dosing variability coupled with the lack of requirement for I V CsA may provide a mechanism for cost savings when Neoral is used for induction immunosuppression. This retrospective case-control study co mpares the relative costs associated with Neoral induction without IV CsA versus induction with IV CsA followed by oral CsA in adult liver t ransplant recipients. Twenty consecutive patients receiving Neoral 12- 15 mg/kg per d were compared to a control group of 21 patients receivi ng IV CsA followed by oral CsA for induction. Both groups received the same rapidly tapered dose of methyl-prednisilone. Health care resourc e utilization was assigned based on days in hospital and acute rejecti on episodes (ARE). Hospital per diem rates at specified care levels we re used to assign costs associated with hospital stay, while a previou sly developed case-costing model was used to assign costs to episodes of acute rejection. All patients were followed for a 3-month period po st-transplant. Although there was a trend towards shorter hospital sta y in the Neoral group the majority of cost savings were achieved by re ducing costs associated with episodes of acute rejection. There were s even and 19 episodes of ARE in the Neoral and IV CsA groups respective ly (p < 0.05.) A separate cost effective assessment of the effect of r educing rejection by decision tree analysis demonstrated a cost reduct ion of $2162 per patient. The savings achieved with Neoral proved robu st on sensitivity analysis. The change of practice to an induction imm unosuppression regimen of Neoral without IV CsA has achieved a cost sa vings in adult river transplantation at our center.