A population-based analysis of immunosuppression therapy after organ transplantation

In this analysis we investigated the dynamics of original and generic immunosuppressive therapies prescribed to patients after organ transplantation, which are highly sensitive to generic drug conversion.

For the analysis pseudonymised data (years 2017 to 2021) were pooled from the Bavarian Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung Bayerns, KVB), covering outpatient contract medical care in Bavaria, and from BARMER Health Insurance, covering inpatient and outpatient care across Germany. The population comprised patients with confirmed transplantation plus outpatient follow-up care.

76.7% (10,287 of 13,424) transplant outpatients from KVB and 76.0% (11,781 of 15,492) patients from BARMER received any immunosuppressive drug. Kidneys were the most common target organ. The most common drugs used were calcineurin inhibitors (KVB 80.2%; BARMER 78.3%), glucocorticoids (KVB 72.6%; BARMER 78.7%), and mycophenolic acid (KVB 64.5%; BARMER 58.7%). In both cohorts, methylprednisolone and tacrolimus use increased over time, while ciclosporin use declined. Patent-protected everolimus and belatacept had the highest cost per patient. However, taking into account the number of recipients, tacrolimus had the highest cost implications for the healthcare system per year (total: KVB €134 million; BARMER €139 million), followed by mycophenolic acid and everolimus. There was a reduction in the use of originator packs for prednisolone, prednisone, methylprednisolone, mycophenolic acid, tacrolimus, and azathioprine in both cohorts and over time. Generic drug use increased from 15.2% of prescribed drug packs in the first quarter of 2017 to 22.7% in the fourth quarter of 2021 in KVB, and from 16.8 to 24.8% in the BARMER dataset.

This population-based analysis of immunosuppressive therapy after organ transplantation in Germany found an increase in the use of generic immunosuppressive drugs between 2017 and 2021, although the increase was lower than expected.