Cost-effectiveness of extending medicare coverage of immunosuppressive medications to the life of a kidney transplant

Eugene F. Yen, Karen Hardinger, Daniel C. Brennan, Robert S. Woodward, Niraj M. Desai, Jeffrey S. Crippin, Brian F. Gage, Mark A. Schnitzler

Research output: Contribution to journalArticlepeer-review

75 Scopus citations

Abstract

Unless they maintain Medicare status through disability or age, kidney transplant recipients lose their Medicare coverage of immunosuppression 3 years after transplantation. A significant transplant survival advantage has previously been demonstrated by the extension of Medicare immunosuppressive medication coverage from 1 year to 3 years, which occurred between 1993 and 1995. The United States Renal Data System (USRDS) was analyzed for recipients of kidney transplants from 1995 to 1999. Using a Markov model, we estimated survival and costs of the current system of 3-year coverage compared with lifetime immunosuppression coverage. Results were calculated from the perspectives of society and Medicare. Extension of immunosuppression coverage produced an expected improvement from 38.6% to 47.6% in graft survival and from 55.4% to 61.8% in patient survival. The annualized expected savings to society from lifetime coverage was $136 million assuming current rates of transplantation. Medicare would break-even compared with current coverage if the fraction of patients using extended coverage was <32%. The extension would be cost-effective to Medicare if this fraction was <91%. Extended Medicare immunosuppression coverage to the life of a kidney transplant should result in better transplant and economic outcomes, and should be considered by policy makers.

Original languageEnglish
Pages (from-to)1703-1708
Number of pages6
JournalAmerican Journal of Transplantation
Volume4
Issue number10
DOIs
StatePublished - Oct 2004

Keywords

  • Immunosuppression
  • Kidney transplantation
  • Medicare
  • Public policy
  • Renal failure

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