A cost-effectiveness analysis of cyclosporine in cadaveric kidney transplantation

Expected costs and health outcomes associated with cadaveric kidney transplantation using cyclosporine (CsA) plus steroids, azathioprine (Aza) plus steroids, and "dialysis only" were estimated from both a societal perspective and a Medicare perspective. Published data on patient and graft survival and treatment costs were incorporated into a Markov model to predict the ten-year experience of hypothetical cohorts of 1,000 35-year-old persons with end-stage renal disease (ESRD) exposed to each treatment option. In the base-case analysis conducted from the societal perspective, ten-year cumulative costs for the "dialysis only," CsA, and Aza cohorts were $181, $147, and $138 million, respectively. Transplantation using CsA rather than Aza would cost an estimated $19,800 per additional life-year and $9,700 per additional graft-year; whereas from Medicare's perspective, CsA would be less costly than Aza. This analysis suggests that under present regulations, widespread use of CsA instead of Aza for cadaveric graft recipients would result in significant cost shifting from Medicare to the private sector; but from a societal perspective, this would result in no, or at worst, relatively inconsequential, additional health expenditures. A policy whereby dollar savings achieved by Medicare from improved graft survival were used to help underwrite the cost of CsA for cadaveric kidney transplants would promote access to this drug and have little impact on the overall cost of care for individuals with ESRD.