Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Cost-utility analysis of pharmacogenomics-guided tacrolimus treatment in Austrian kidney transplant recipients participating in the U-PGx PREPARE study

The Pharmacogenomics Journal volume 24, Article number: 10 (2024) Cite this article

Subjects

Abstract

Chronic kidney disease (CKD) is a global health issue. Kidney failure patients may undergo a kidney transplantation (KTX) and prescribed an immunosuppressant medication i.e., tacrolimus. Tacrolimus’ efficacy and toxicity varies among patients. This study investigates the cost-utility of pharmacogenomics (PGx) guided tacrolimus treatment compared to the conventional approach in Austrian patients undergone KTX, participating in the PREPARE UPGx study. Treatment’s effectiveness was determined by mean survival, and utility values were based on a Visual Analog Scale score. Incremental Cost-Effectiveness Ratio was also calculated. PGx-guided treatment arm was found to be cost-effective, resulting in reduced cost (3902 euros less), 6% less hospitalization days and lower risk of adverse drug events compared to the control arm. The PGx-guided arm showed a mean 0.900 QALYs (95% CI: 0.862–0.936) versus 0.851 QALYs (95% CI: 0.814–0.885) in the other arm. In conclusion, PGx-guided tacrolimus treatment represents a cost-saving option in the Austrian healthcare setting.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Scatter plot of probabilistic analysis.
Fig. 2: Cost-effectiveness acceptability curve of PGx-guided group vs control group.

Similar content being viewed by others

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Jones-Hughes T, Snowsill T, Haasova M, Coelho H, Crathorne L, Cooper C, et al. Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model. NIHR J Libr. 2016;20:1–594.

    Google Scholar 

  2. Mudiayi D, Shojai S, Okpechi I, Christie EA, Wen K, Kamaleldin M, et al. Global estimates of capacity for kidney transplantation in world countries and regions. Transplantation. 2022;106:1113–22.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chemello C, Aguilera M, Cañadas Garre M, Calleja MA. Pharmacogenetics and pharmacogenomics of chronic kidney disease comorbidities and kidney transplantation. In: Barh D et al., editors. Omics for personalized medicine. 1st ed. India: Springer eBooks; 2013. p.801–18.

  4. Boenink R, Kramer A, Tuinhout RE, Savoye E, Åsberg A, Idrizi A, et al. Trends in kidney transplantation rate across Europe: study from the ERA Registry. Nephrol Dial Transpl. 2023;38:1528–39.

    Article  Google Scholar 

  5. McEwan P, Dixon S, Baboolal K, Conway P, Currie CJ. Evaluation of the cost effectiveness of sirolimus versus tacrolimus for immunosuppression following renal transplantation in the UK. Pharmacoeconomics. 2006;24:67–79.

    Article  CAS  PubMed  Google Scholar 

  6. Glassock RJ, Warnock DG, Delanaye P. The global burden of chronic kidney disease: estimates, variability and pitfalls. Nat Rev Nephrol. 2017;13:104–14.

    Article  CAS  PubMed  Google Scholar 

  7. Rancic N, Dragojevic-Simic V, Vavic N, Kovacevic A, Segrt Z, Djordjevic N. Economic evaluation of pharmacogenetic tests in patients subjected to renal transplantation: a review of literature. Front Public Health. 2016;4:189–97.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Provenzani A, Santeusanio A, Mathis E, Notarbartolo M, Labbozzetta M, Poma P, et al. Pharmacogenetic considerations for optimizing tacrolimus dosing in liver and kidney transplant patients. World J Gastroenterol. 2013;19:9156–73.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Turolo S, Edefonti A, Syren ML, Montini G. Pharmacogenomics of old and new immunosuppressive drugs for precision medicine in kidney transplantation. J Clin Med. 2023;12:4454–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Adams SM, Crisamore KR, Empey PE. Clinical pharmacogenomics: applications in nephrology. Clin J Am Soc Nephrol. 2018;13:1561–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Nguyen TT, Pearson RA, Mohamed ME, Schladt DP, Berglund D, Rivers Z, et al. Pharmacogenomics in kidney transplant recipients and potential for integration into practice. J Clin Pharm Ther. 2020;45:1457–65.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Crowley LE, Mekki M, Chand S. Biomarkers and pharmacogenomics in kidney transplantation. Mol Diagn Ther. 2018;22:537–50.

    Article  CAS  PubMed  Google Scholar 

  13. Chen L, Prasad GVR. CYP3A5 polymorphisms in renal transplant recipients: influence on tacrolimus treatment. Pharmgenomics Pers Med. 2018;11:23–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Lamba J, Hebert JM, Schuetz EG, Klein TE, Altman RB. PharmGKB summary: very important pharmacogene information for CYP3A5. Pharmacogenet Genomics. 2012;22:555–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Swen JJ, van der Wouden CH, Manson LE, Abdullah-Koolmees H, Blagec K, Blagus T, et al. A 12-gene pharmacogenetic panel to prevent adverse drug reactions: an open-label, multicentre, controlled, cluster-randomised crossover implementation study. Lancet. 2023;401:347–56.

    Article  CAS  PubMed  Google Scholar 

  16. van der Wouden CH, Cambon-Thomsen A, Cecchin E, Cheung KC, Dávila-Fajardo CL, Deneer VH, et al. Implementing pharmacogenomics in Europe: design and implementation strategy of the ubiquitous pharmacogenomics consortium. Clin Pharm Ther. 2017;101:341–58.

    Article  Google Scholar 

  17. Gordois AL, Toth PP, Quek RG, Proudfoot EM, Paoli CJ, Gandra SR. Productivity losses associated with cardiovascular disease: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2016;16:759–69.

    Article  PubMed  Google Scholar 

  18. Willan AR, Briggs A. Statistical analysis of cost‐effectiveness data. 1st ed. Canada: John Wiley & Sons Ltd; 2006.

    Book  Google Scholar 

  19. General Hospital of Vienna, Clinical Insitute of Medical Analysis. Catalog of Parameters. 2023. https://www.akhwien.at/default.aspx?pid=3982.

  20. Chung R, Howard K, Craig JC, Chapman JR, Turner R, Wong G. Economic evaluations in kidney transplantation: frequency, characteristics, and quality-a systematic review. Transplantation. 2014;97:1027–33.

    Article  PubMed  Google Scholar 

  21. Vannaprasaht S, Limwattananon C, Anutrakulchai S, Chan-On C. Effect of CYP3A5 genotype on hospitalization cost for kidney transplantation. Int J Clin Pharm. 2019;41:88–95.

    Article  CAS  PubMed  Google Scholar 

  22. Pasternak AL, Kidwell KM, Dempsey JM, Gersch CL, Pesch A, Sun Y, et al. Impact of CYP3A5 phenotype on tacrolimus concentrations after sublingual and oral administration in lung transplant. Pharmacogenomics. 2019;20:421–32.

    Article  CAS  PubMed  Google Scholar 

  23. Koufaki MI, Fragoulakis V, Díaz-Villamarín X, Karamperis K, Vozikis A, Swen JJ, et al. Economic evaluation of pharmacogenomic-guided antiplatelet treatment in Spanish patients suffering from acute coronary syndrome participating in the U-PGx PREPARE study. Hum Genomics. 2023;17:51–66.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fragoulakis V, Roncato R, Bignucolo A, Patrinos GP, Toffoli G, Cecchin E, et al. Cost-utility analysis and cross-country comparison of pharmacogenomics-guided treatment in colorectal cancer patients participating in the U-PGx PREPARE study. Pharm Res. 2023;197:106949–58.

    Article  CAS  Google Scholar 

  25. Skokou M, Karamperis K, Koufaki MI, Tsermpini EE, Pandi MT, Siamoglou S, et al. Clinical implementation of preemptive pharmacogenomics in psychiatry. eBioMedicine. 2024;101:105009–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Verbelen M, Weale ME, Lewis CM. Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet? Pharmacogenomics J. 2017;17:395–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The project was funded by the European Commission Horizon 2020 Program via Grant Agreement 668353 (U-PGx; www.upgx.eu) to CM.

Author information

Author notes

  1. These authors contributed equally: Vasileios Fragoulakis, Margarita-Ioanna Koufaki.

Authors and Affiliations

  1. The Golden Helix Foundation, London, UK

    Vasileios Fragoulakis & Christina Mitropoulou

  2. Department of Pharmacy, Laboratory of Pharmacogenomics and Individualized Therapy, University of Patras, School of Health Sciences, Patras, Greece

    Margarita-Ioanna Koufaki

  3. Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria

    Candace Joefield-Roka & Gere Sunder-Plassmann

  4. Department of Genetics and Genomics, United Arab Emirates University, College of Medicine and Health Sciences, Al-Ain, Abu Dhabi, United Arab Emirates

    Christina Mitropoulou

Authors
  1. Vasileios Fragoulakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margarita-Ioanna Koufaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Candace Joefield-Roka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gere Sunder-Plassmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christina Mitropoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the conception, design and drafting of the paper. CJR and GSP performed data collection and documentation in eCRF and were part of the Austrian clinical team working on the PREPARE study. CM was one of the delegated persons, responsible for the design and the conduction of PREPARE project. VF and MIK reviewed and purified the study’s database. VF and MIK conducted data analysis. VF and MIK drafted the first and all subsequent versions of this paper. All authors reviewed and approved the final version of paper. VF and MIK are the guarantor for the overall content.

Corresponding author

Correspondence to Christina Mitropoulou.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval

The study was approved by ethics committee of the Medical University of Vienna, Vienna, Austria.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fragoulakis, V., Koufaki, MI., Joefield-Roka, C. et al. Cost-utility analysis of pharmacogenomics-guided tacrolimus treatment in Austrian kidney transplant recipients participating in the U-PGx PREPARE study. Pharmacogenomics J 24, 10 (2024). https://doi.org/10.1038/s41397-024-00330-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41397-024-00330-5

Search

Advanced search

Quick links