BACKGROUND Kidney transplant recipients must take immunosuppressant drugs to prevent rejection and maintain transplant function. Medicare coverage of immunosuppressant drugs for kidney transplant recipients ceases 36 months after transplantation, potentially increasing the risk of transplant failure. A contemporary economic analysis of extending Medicare coverage for the duration of transplant survival using current costs of immunosuppressant medications in the era of generic equivalents may inform immunosuppressant drug policy. METHODS A Markov model was used to determine the incremental cost and effectiveness of extending Medicare coverage for immunosuppressive drugs over the duration of transplant survival, compared with the current policy of 36-month coverage, from the perspective of the Medicare payer. The expected improvement in transplant survival by extending immunosuppressive drug coverage was estimated from a cohort of privately insured transplant recipients who receive lifelong immunosuppressant drug coverage compared with a cohort of Medicare-insured transplant recipients, using multivariable survival analysis. RESULTS Extension of immunosuppression Medicare coverage for kidney transplant recipients led to lower costs of -$3077 and 0.37 additional quality-adjusted life years (QALYs) per patient. When the improvement in transplant survival associated with extending immunosuppressant coverage was reduced to 50% of that observed in privately insured patients, the strategy of extending drug coverage had an incremental cost-utility ratio of $51,694 per QALY gained. In a threshold analysis, the extension of immunosuppression coverage was cost-effective at a willingness-to-pay threshold of $100,000, $50,000, and $0 per QALY if it results in a decrease in risk of transplant failure of 5.5%, 7.8%, and 13.3%, respectively. CONCLUSIONS Extending immunosuppressive drug coverage under Medicare from the current 36 months to the duration of transplant survival will result in better patient outcomes and cost-savings, and remains cost-effective if only a fraction of anticipated benefit is realized.

中文翻译：

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当前时代扩展肾脏移植受者医疗保险免疫抑制药物覆盖率的经济评估。

背景技术肾移植受者必须服用免疫抑制剂以防止排斥反应并维持移植功能。移植后36个月，Medicare对肾脏移植接受者的免疫抑制剂药物的覆盖范围停止，可能会增加移植失败的风险。使用通用仿制药时代当前免疫抑制剂药物的当前成本扩大Medicare覆盖范围以延长移植生存期的当代经济分析，可能会为免疫抑制剂药物政策提供依据。方法从目前的医疗保险付款人角度来看，与目前的36个月保险政策相比，使用马尔可夫模型确定了在移植生存期间，扩大免疫抑制药物医疗保险覆盖范围的增量成本和有效性。使用多变量生存分析，根据一组接受终身免疫抑制剂药物覆盖的私人保险移植接受者与一组由Medicare保险的移植接受者相比，估计通过扩大免疫抑制药物覆盖范围而预期的移植生存改善。结果扩大肾脏移植接受者的免疫抑制Medicare覆盖范围可降低每位患者3077美元的成本和0.37额外的质量调整生命年（QALYs）。当与扩大免疫抑制剂覆盖率相关的移植存活率降低到私人保险患者所观察到的50％时，扩大药物覆盖率的策略每获得QALY的成本-效用比为51,694美元。在阈值分析中，免疫抑制覆盖率的扩展在每个QALY的支付意愿门槛分别为100,000美元，50,000美元和0美元的情况下具有成本效益，如果这将使移植失败的风险分别降低5.5％，7.8％和13.3％。结论将Medicare的免疫抑制药物覆盖范围从目前的36个月延长到移植生存期，将可以改善患者的治疗效果并节省成本，并且如果仅实现预期收益的一小部分，则仍然具有成本效益。