Abstract
Chronic kidney disease is ranked fourth among the top 10 causes of death in Saudi Arabia. Renal transplantation has been recognized as the treatment of choice compared with long-term dialysis to maintain graft survival and prolong a patient’s healthy living. Immunosuppressants (ISs) must be administered lifelong. The choice between IS therapies can be challenging because of the similarity in efficacy with some differences in adverse events profile. The objective of this study was to assess the cost-effectiveness of different IS regimens in Saudi Arabia.
A 25-year Markov model was developed based on a previously published study from the Saudi Ministry of Health payer perspective. Efficacy parameters were driven from the literature, whereas cost data were estimated from the Ministry of Health database. A Monte Carlo simulation was conducted to test the base-case model results’ robustness.
All comparators resulted in 6.2 quality-adjusted life-years (QALYs) except for Advagraf® treatment (5.5 QALYs). Generic tacrolimus plus mycophenolate mofetil (MMF) will cost 70 701.45 US dollars ($) (Saudi riyal 265 130.44) per patient to gain 6.2 QALYs over 25 years’ time horizon. In the improved adherence scenario, Envarsus® plus generic MMF generated 9.6 QALYs with a cost of $59 849 per patient. Monte Carlo simulation results have shown that generic tacrolimus is still the cheapest treatment option compared with other treatment arms.
The current analysis suggested that all IS options are not cost-effective strategies relative to the willingness-to-pay threshold of $20 000. Nevertheless, Envarsus plus generic MMF regimen could become the most cost-effective regimen at different willingness-to-pay thresholds.
•To the best of our knowledge, this is the first economic evaluation conducted on renal transplant patients in the Kingdom of Saudi Arabia. The current analysis studied the cost and outcomes of different Immunosuppressant (IS) regimens from a payer perspective for 25 years’ time horizon with an annual cycle length.•The comparators included in the analysis were IS regimes used in the Saudi Ministry of Health (MOH) clinical practice. The outcome measures were majorly derived from the literature; nevertheless, the cost of drugs was obtained from National Unified Procurement Company and resource utilization from the MOH services price list.•The current analysis demonstrated that IS therapy is not cost-effective at the US dollar 20 000 willingness-to-pay threshold, although they were associated with substantial clinical and patient-reported outcomes benefits, which is not necessarily advised against the use of ISs for life; nevertheless, the prices of medications might be revised for resubmission at the MOH level. Further studies are required to reconduct the analysis by adopting local patients and outcomes data to reflect real-world clinical practice in the Kingdom of Saudi Arabia.