TWO-HOUR POST-DOSE CYCLOSPORINE LEVELS IN RENAL TRANSPLANTATION IN ARGENTINA: A COST-EFFECTIVE STRATEGY FOR REDUCING ACUTE REJECTION

Monitoring of cyclosporine (microemulsion CsA) at 2 hours post-dose (C 2 ), a measure of absorption and exposure, appears superior to trough (C 0 ) monitoring for prediction of rejection risk. The purpose of this study was to determine whether C 2 was cost-effective compared to C 0 in Argentina. Methods. A predictive decision model was adapted to Argentina to predict costs associated with C 0 and C 2 measurements in the first year after transplantation. Patients were treated with microemulsion CsA, steroids and azathioprine or MMF. Parameter estimates for the C 0 strategy were based on event rates observed in published clinical trials. The model was adapted to Argentinean health system through local protocols and expert opinions; costs were valued in Argentinean pesos and converted to US dollars (1 USD = 2.85 ARS). Results. Incidence of acute rejection was predicted to be 25.0% at 1-year among patients monitored by C 0 and 18.0% by C 2 . Graft survival was predicted to be 1.4% lower in the C 0 group. No important differences were identified in co-morbidity, C 0 and C 2 monitoring costs, and in ambulatory-based adverse events between C 0 and C 2 cohorts. The model predicted an average cost per patient of $16,269 for C 0 and $16,343 for C 2 testing (year 1). Sensitivity analyses indicated that the average daily dose of microemulsion CsA was the most important parameter leading to the incremental cost per patient. Conclusions. C 2 is expected to provide a potentially important reduction in the risk of acute rejection without increasing the estimated cost of care in the first year post-transplant.