Immunosuppressive Drug Costs Decline, But Still Expensive
SEATTLE—Annual per-patient costs of maintenance immunosuppressive medications for kidney transplant recipients has declined since 2007, but the cost was twice as high in 2011 as it was in 1993, according to data presented at the 2013 American Transplant Congress.
Adjusted for inflation and expressed in 2012 dollars, the annual per-patient cost rose from $9,280 in 1993 to a high of $33,040 in 2007 and then declined to $18,746 in 2011, Roger W. Evans, PhD, of the United Network for the Recruitment of Transplantation Professionals in Rochester, Minn., reported.
The costs for other solid organ transplant (SOT) patients followed a similar pattern. For liver transplant patients, the annual per-patient cost rose from $9,280 in 1993 to $34,832 in 2007 and then dropped to $23,999 in 2011. For heart transplant recipients, the annual per-patient cost rose from $9,280 in 1993 to $32,928 in 2007 and $31,209 in 2011.
Although the per-patient costs in general have declined at times, Dr. Evans' analysis shows that they now are increasing.
Since 1993, insurance actuaries have periodically published estimates of the costs associated with maintenance immunosuppressive medications, Dr. Evans said. These published reports served as the basis for his analysis.
The decline in costs from 2007 probably is due to the availability of generic versions of some immunosuppressive drugs, such as cyclosporine, tacrolimus, and mycophenolate mofetil, Dr. Evans said. He pointed out, however, that concerns about the bioequivalency of some generics could dissuade doctors from prescribing them, leading to cost increases.
The high cost of immunosuppressive drugs is an important factor in patient non-adherence to treatment, Dr. Evans said. About 8.3% of kidney transplant patients have no insurance coverage, he said. They either pay out of pocket or transplant centers write off the cost of the drug. Another 23.5% of kidney transplant recipients do not have prescription drug coverage and rely on industry-sponsored pharmacy assistance programs.
In a previous survey of 254 U.S. kidney transplant centers (Clin J Am Soc Nephrol 2010;5:2323-2328), Dr. Evans and colleagues found that more than 70% of these centers reported that their patients have an extremely or very serious problem paying for their medications. About 47% of the centers indicated that more than 40% of their patients are having difficulty paying for their immunosuppressive medications. Additionally, 68% of the programs report deaths and graft losses attributable to cost-related immunosuppressive medication non-adherence.
Additionally, Dr. Evans noted, the survey found that many centers were not putting dialysis patients on a transplant waiting list because they could not pay for the immunosuppressive drugs.