Cost-Effectiveness of Modern Mtor Inhibitor Based Immunosuppression Compared to the Standard
Cost-effectiveness of modern mTOR inhibitor based immunosuppression compared to the standard of care after renal transplantation in Germany
Supplementary material
Sensitivity Analyses
Table A: Average costs per patient (12 months, 10 years, sensitivity analysis 1).
Average costs per patient(EUR, 12 months) / Average costs per patient
(EUR, 10years)
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / 26,310 / 146,078
TR 2: Sirolimus-early-transition / 19,424 / 116,153
TR 3: Everolimus-early-transition / 24,925 / 155,524
TR 4: Tacrolimus low dose+MMF+steroids / 18,538 / 126,779
EUR: Euro, TR: Therapy Regimen
Table B: Results of the MTC analysis (annual event probabilities for year 1, sensitivity analysis 2)
Event / Therapy regimen1 / 2 / 3 / 4
Death (all causes) / 15.70
(0.1-82.8) / 1.90
(0-11.3) / 0.09
(0-0.1) / 3.30
(0.1-20.9)
Graft failure / 8.00
(0.2-46.0) / 5.40
(0.3-25.5 / 32.30
(0.0-100) / 3.20
(0.1-16.2)
Malignancies (total) / 6.37
(0.0-55.9) / 4.58
(0.1-25.7) / 8.59
(0.1-51.6) / 12.81
(0.2-66.9)
Post-transplant hypertension treatment (probability per year) / 24.72
(0.4-89.4) / 18.77
(0.9-66.1) / 30.10
(1.3-87.3) / 27.48
(1.2-84.7)
Probabilities (%) for 1 year with initial immunosuppressive regimen; credibility intervals presented in parentheses
Table C:Outcomes for 12 months simulation (average costs,LYs, and years with FG per patient, sensitivity analysis 2).
Average cost per patient (EUR) / Average LY per patient / Average years with FG per patientTR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / 25,607 / 0.925 / 0.892
TR 2: Sirolimus-early-transition / 17,488 / 0.990 / 0.967
TR 3: Everolimus-early-transition / 31,226 / 0.958 / 0.814
TR 4: Tacrolimus low dose+MMF+steroids / 16,264 / 0.984 / 0.971
TR: Therapy Regimen; LY: Life Years; FG: Functioning Graft
Table D: ICER in Euro per LY gainedfor 12 months (sensitivity analysis 2).
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids vs. / TR 2: Sirolimus-early-transition vs. / TR 3: Everolimus-early-transition vs. / TR 4: Tacrolimus low dose+MMF+steroids vs.TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / N.A. / Dominates
(+) / N.E. / Dominates
(+)
TR 2: Sirolimus-early-transition / Dominated
(−) / N.A. / Dominated
(−) / N.E.
TR 3: Everolimus-early-transition / 170,273 / Dominates
(+) / N.A. / Dominates
(+)
TR 4: Tacrolimus low dose+MMF+steroids / Dominated
(−) / 204,000 / Dominated
(−) / N.A.
Note: ICERs/dominance for therapy regimen in the top row versus therapy regimen in the left column.
(+) indicates a domination of the therapy regimen in the top row versus therapy regimen in the left column.
(−) indicates a domination of the therapy regimen in the left column versus therapy regimen top row.
N.A.: ICER calculation not possible; N.E.: lower effects at lower costs, no ICER derived
TR: Therapy Regimen; LY: Life Years
Table E: ICER in Euro peryear with FG gainedfor 12 months (sensitivity analysis 2).
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids vs. / TR 2: Sirolimus-early-transition vs. / TR 3: Everolimus-early-transition vs. / TR 4: Tacrolimus low dose+MMF+steroids vs.TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / N.A. / Dominates
(+) / Dominated
(−) / Dominates
(+)
TR 2: Sirolimus-early-transition / Dominated
(−) / N.A. / Dominated
(−) / Dominates
(+)
TR 3: Everolimus-early-transition / Dominates
(+) / Dominates
(+) / N.A. / Dominates
(+)
TR 4: Tacrolimus low dose+MMF+steroids / Dominated
(−) / Dominated
(−) / Dominated
(−) / N.A.
Note: ICERs/dominance for therapy regimen in the top row versus therapy regimen in the left column.
(+) indicates a domination of the therapy regimen in the top row versus therapy regimen in the left column.
(−) indicates a domination of the therapy regimen in the left column versus therapy regimen top row.
N.A.: ICER calculation not possible; N.E.: lower effects at lower costs, no ICER derived
TR: Therapy Regimen; LY: Life Years
Table F:Outcomes for 10 years simulation (average costs,LYs, and years with FG per patient, sensitivity analysis 2).
Average cost per patient (EUR) / Average LY per patient / Average years with FG per patientTR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / 144,763 / 5.626 / 5.003
TR 2: Sirolimus-early-transition / 108,048 / 6.509 / 5.857
TR 3: Everolimus-early-transition / 160,569 / 5.464 / 4.185
TR 4: Tacrolimus low dose+MMF+steroids / 114,457 / 6.495 / 5.915
TR: Therapy Regimen; LY: Life Years; FG: Functioning Graft
Table G: ICER in Euro per LY gainedfor 10 years (sensitivity analysis 2).
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids vs. / TR 2: Sirolimus-early-transition vs. / TR 3: Everolimus-early-transition vs. / TR 4: Tacrolimus low dose+MMF+steroids vs.TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / N.A. / Dominates
(+) / Dominated
(−) / Dominates
(+)
TR 2: Sirolimus-early-transition / Dominated
(−) / N.A. / Dominated
(−) / Dominated
(-)
TR 3: Everolimus-early-transition / Dominates
(+) / Dominates
(+) / N.A. / Dominates
(+)
TR 4: Tacrolimus low dose+MMF+steroids / Dominated
(−) / Dominates
(+) / Dominated
(−) / N.A.
Note: ICERs/dominance for therapy regimen in the top row versus therapy regimen in the left column.
(+) indicates a domination of the therapy regimen in the top row versus therapy regimen in the left column.
(−) indicates a domination of the therapy regimen in the left column versus therapy regimen top row.
N.A.: ICER calculation not possible; N.E.: lower effects at lower costs, no ICER derived
TR: Therapy Regimen; LY: Life Years
Table H: ICER in Euro peryear with FG gainedfor 10 years (sensitivity analysis 2).
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids vs. / TR 2: Sirolimus-early-transition vs. / TR 3: Everolimus-early-transition vs. / TR 4: Tacrolimus low dose+MMF+steroids vs.TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / N.A. / Dominates
(+) / Dominated
(−) / Dominates
(+)
TR 2: Sirolimus-early-transition / Dominated
(−) / N.A. / Dominated
(−) / 110,500
TR 3: Everolimus-early-transition / Dominates
(+) / Dominates
(+) / N.A. / Dominates
(+)
TR 4: Tacrolimus low dose+MMF+steroids / Dominated
(−) / N.E. / Dominated
(−) / N.A.
Note: ICERs/dominance for therapy regimen in the top row versus therapy regimen in the left column.
(+) indicates a domination of the therapy regimen in the top row versus therapy regimen in the left column.
(−) indicates a domination of the therapy regimen in the left column versus therapy regimen top row.
N.A.: ICER calculation not possible; N.E.: lower effects at lower costs, no ICER derived
TR: Therapy Regimen; LY: Life Years
Table I : Average costs per patient (12 months, 10 years).
Average costs per patient(12 months) / Average costs per patient
(10 years)
lower value / base case / upper value / lower value / base case / upper value
± 50% change in drug costs (incl. co-med.)
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / 16,003 / 26,011 / 36,020 / 96,276 / 145,788 / 196,256
TR 2: Sirolimus-early-transition / 11,016 / 17,500 / 23,915 / 75,948 / 107,246 / 139,302
TR 3: Everolimus-early-transition / 16,238 / 24,225 / 32,212 / 105,181 / 154,822 / 206,403
TR 4: Tacrolimus low dose+MMF+steroids / 9,970 / 16,404 / 22,838 / 80,437 / 114,612 / 150,517
± 50% change in costs of dialysis
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / 24,256 / 26,011 / 27,862 / 128,431 / 145,788 / 164,361
TR 2: Sirolimus-early-transition / 16,316 / 17,500 / 18,620 / 89,170 / 107,246 / 125,642
TR 3: Everolimus-early-transition / 21,630 / 24,225 / 26,676 / 133,219 / 154,822 / 177,842
TR 4: Tacrolimus low dose+MMF+steroids / 15,631 / 16,404 / 17,088 / 97,974 / 114,612 / 132,363
± 50% change in costs of acute rejection and graft failure
TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids / 25,579 / 26,011 / 26,462 / 144,949 / 145,788 / 147,177
TR 2: Sirolimus-early-transition / 16,835 / 17,500 / 18,098 / 105,991 / 107,246 / 107,703
TR 3: Everolimus-early-transition / 23,488 / 24,225 / 24,866 / 153,370 / 154,822 / 156,651
TR 4: Tacrolimus low dose+MMF+steroids / 16,147 / 16,404 / 16,635 / 113,842 / 114,612 / 115,684
TR: Therapy Regimen
Table J: ICERs affected by a ±20% of the probability for acute rejection(sensitivity analysis 4)
lower value / base case / upper valueTR 2: Sirolimus-early-transition vs. TR 4: Tacrolimus low dose+MMF+steroids (12 months)
ICER in Euro per LY gained / 466,000 / 548,000 / 620,500
TR 3: Everolimus-early-transition vs. TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids (10 years)
ICER in Euro per LY gained / 24,456 / 26,571 / 27,266
ICER in Euro per year with FG gained / 40,929 / 45,626 / N.A.
TR 4: Tacrolimus low dose+MMF+steroids vs. TR 2: Sirolimus-early-transition (10 years)
ICER in Euro per LY gained / N.A. / 387,684 / 453,706
ICER in Euro per year with FG gained / 84,154 / 102,306 / N.A.
TR: Therapy Regimen; N.A.: Use of lower/upper values from sensitivity analysis does not affect the lower/upper value of the simulation results
Table K: ICERs affected by a ±20% of the probability for graft failure (sensitivity analysis 5)
lower value / base case / upper valueTR 2: Sirolimus-early-transition vs. TR 4: Tacrolimus low dose+MMF+steroids (12 months)
ICER in Euro per LY gained / 474,000 / 548,000 / 620,500
TR 3: Everolimus-early-transition vs. TR 1: Sirolimus+early withdrawal of Cyclosporine +steroids (10 years)
ICER in Euro per LY gained / N.A. / 26,571 / 26,841
ICER in Euro per year with FG gained / 43,875 / 45,626 / N.A.
TR 4: Tacrolimus low dose+MMF+steroids vs. TR 2: Sirolimus-early-transition (10 years)
ICER in Euro per LY gained / 379,947 / 387,684 / 616,077
ICER in Euro per year with FG gained / 88,011 / 102,306 / 124,466
TR: Therapy Regimen; N.A.: Use of lower/upper values from sensitivity analysis does not affect the lower/upper value of the simulation results
Table L: SHI costs (generic) on mg basis (Lauer-Fischer (2012). WEBAPO® LAUER-Taxe (Stand 29.03.2012))
