Assessing the cost-effectiveness of replacing antimetabolites with mTOR inhibitors in heart transplant immunosuppression in China: a network meta-analysis-based economic evaluation

Yajie Gu; Bing Liu; Xiaonan Lin; Jinjin Chen; Xin Chen; Yingshuo Jiang; Yifan Zhu; Xin Li; Sheng Lou; Junrong Zhu

doi:10.1007/s11096-024-01793-z

Assessing the cost-effectiveness of replacing antimetabolites with mTOR inhibitors in heart transplant immunosuppression in China: a network meta-analysis-based economic evaluation

Int J Clin Pharm. 2024 Sep 24. doi: 10.1007/s11096-024-01793-z. Online ahead of print.

Authors

Yajie Gu^#^{1

2}, Bing Liu^#^{1

2}, Xiaonan Lin^{1

2}, Jinjin Chen^{1

2}, Xin Chen³, Yingshuo Jiang³, Yifan Zhu³, Xin Li^{4

5}, Sheng Lou^{1

2}, Junrong Zhu^{6

7}

Affiliations

¹ Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, 210006, China.
² Department of Pharmacy, Nanjing First Hospital, Nanjing Hospital Afiliated to Nanjing Medical University, Nanjing, 210006, China.
³ Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China.
⁴ School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
⁵ Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
⁶ Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, 210006, China. jrzhu@cpu.edu.cn.
⁷ Department of Pharmacy, Nanjing First Hospital, Nanjing Hospital Afiliated to Nanjing Medical University, Nanjing, 210006, China. jrzhu@cpu.edu.cn.

^# Contributed equally.

PMID: 39316305
DOI: 10.1007/s11096-024-01793-z

Abstract

Background: Although several pharmacoeconomic studies have assessed the cost-effectiveness of maintenance immunosuppressive regimens for heart transplant recipients, economic comparisons between various combination drug therapies remain sparse.

Aim: This study used an economic evaluation based on network meta-analysis to assess the cost-effectiveness of four immunosuppressive regimens for adult heart transplant recipients in China.

Method: We conducted a systematic search for clinical trials in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP database. A validated Markov model was adapted to reflect the Chinese medical landscape. Four maintenance immunosuppression regimens were considered: tacrolimus/mycophenolate mofetil (TAC/MMF), cyclosporine/mycophenolate mofetil (CSA/MMF), everolimus/cyclosporine (EVL/CSA), and sirolimus/tacrolimus (SRL/TAC). The probabilities of health events were derived from a comprehensive literature review. Direct medical costs, adjusted for 2022 values, were from public documents and websites, while utilities for quality-adjusted life-years (QALYs) were taken from previous studies. Primary outcomes were mean lifetime cost, QALYs, and cost-effectiveness, with a willingness-to-pay (WTP) threshold set at three times China's GDP per capita in 2022. Sensitivity analyses were conducted to test the robustness of the results.

Results: The base case analysis identified TAC/MMF as the most cost-effective regimen, producing a mean of 6.31 QALYs per patient at a cost of Chinese Yuan (CNY) 534,182.89. Sensitivity analyses consistently reinforced TAC/MMF as the most cost-effective and robust choice.

Conclusion: TAC/MMF is the most cost-effective maintenance immunosuppressive regimen for heart transplant recipients within the Chinese health system. The study findings are reinforced by sensitivity analyses, affirming their robustness amid various uncertainties.

Keywords: Cost-effectiveness; Heart transplantation; Immunosuppression; Long-term simulation; Markov model.

Grants and funding

2023YX001/Nanjing Pharmaceutical Society - Changzhousiyao Hospital Pharmaceutical Research Fund