Share This Article:

Trends in use and costs of prescription medication in patients with type 1 diabetes: 9-year follow-up after kidney transplantation

DOI: 10.4236/jdm.2013.31001    3,050 Downloads   5,899 Views  

ABSTRACT

Aims: Weestimated long-term trends in prescription medication utilization and costs in patients with type 1 diabetes in two different transplant cohorts (Group 1: transplantation 1986-1999,n = 180; Group 2: transplantation 2000-2008, n = 150). Methods: Data obtained from the Finnish Diabetic Nephropathy Study were linked with the Drug Prescription Register (purchases of medications 1995-2009). Generalized linear mixed models under gamma distribution were used to evaluate the medication costs. Results: The total costs of medication decreased (Group 1 from€11,290 to €8760; Group 2 from €12,800 to €9790)during the follow-up (P< 0.0001). The sametrend was observed for immunosuppressive drugcosts (P< 0.0001). Although the cost profiles were similar for the groups (P= 0.9), the cost level in Group 2 was higher than in Group 1 (P< 0.0001). In Group 1 the most common immunosuppressive combination was cyclosporine, azathioprine and corticosteroid, while cyclosporine, mycophenolate mofetil (MMF) with/without corticosteroid was the most common in Group 2. The estimated average costs of cyclosporine in combination withMMFwere 84% (€4130) higher than with azathioprine. Conclusions: Since diabetes or other drugs had only marginal impact on the total costs, the decreasing trend wasmainly due to the costs of immunosuppressants.This finding is consistent with the recent guidelines which recommend reducing doses of immunosuppressants over time to minimize sideeffects.The cost levels differed depending on the combinations of immunosuppressive drugs in use. Those who had MMF in the regimen generated higher costs.


Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Lithovius, R. , Harjutsalo, V. , Forsblom, C. , Saraheimo, M. , Koskinen, P. and Groop, P. (2013) Trends in use and costs of prescription medication in patients with type 1 diabetes: 9-year follow-up after kidney transplantation. Journal of Diabetes Mellitus, 3, 1-10. doi: 10.4236/jdm.2013.31001.

References

[1] Gross, J.L., de Azevedo, M.J., Silveiro, S.P., Canani, L.H., Caramori, M.L. and Zelmanovitz, T. (2005) Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes Care, 28, 164-176. doi:10.2337/diacare.28.1.164
[2] Luan, F.L. and Samaniego, M. (2010) Transplantation in diabetic kidney failure patients: Modalities, outcomes, and clinical management. Seminars in Dialysis, 23, 198-205. doi:10.1111/j.1525-139X.2010.00708.x
[3] Lithovius, R., Harjutsalo, V., Forsblom, C. and Groop, P.H. and FinnDiane Study Group (2011) Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland. Diabetologia, 54, 496-503. doi:10.1007/s00125-010-1999-y
[4] Salonen, T., Reina, T., Oksa, H., Sintonen, H. and Pasternack, A. (2003) Cost analysis of renal replacement therapies in Finland. American Journal of Kidney Diseases, 42, 1228-1238. doi:10.1053/j.ajkd.2003.08.024
[5] Wolfe, R.A., Ashby, V.B., Milford, E.L., et al. (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. New England Journal of Medcine, 341, 1725-1730. doi:10.1056/NEJM199912023412303
[6] Kho, M., Cransberg, K., Weimar, W. and van Gelder, T. (2011) Current immunosuppressive treatment after kidney transplantation. Expert Opin Pharmacother, 12, 1217-1231. doi:10.1517/14656566.2011.552428
[7] National Institute for Clinical Excellence (2005) TA85: Renal transplantation—Immunosuppressive regimens (adults). The clinical effectiveness and cost-effectiveness of immunesuppressive therapy for renal transplantation. Nice, London. www.nice.org.uk/TA85guidance.
[8] Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. American Journal of Transplantation, 9, S1-S155. doi:10.1111/j.1600-6143.2009.02834.x
[9] Jurgensen, J.S., Arns, W. and Hass, B. (2010) Cost-effectiveness of immunosuppressive regimens in renal transplant recipients in Germany: A model approach. The European Journal of Health Economics, 11, 15-25. doi:10.1007/s10198-009-0148-3
[10] Mao, P.C., Lee, E.K. and Tseng, P.L. (2012) Trends in the use of immunosuppressive agents by outpatients after renal transplantation at a medical center in southern Taiwan. Transplantation Proceedings, 44, 185-189. doi:10.1016/j.transproceed.2011.11.003
[11] Gentil, M.A., Cantarell, A.C., Gonzalez, R.F.M., Marco, F.J.E., Lopez, De M.M.M. (2004) Impact of the new drugs in the cost of maintenance immunosuppression of renal transplantation. Is it justified? Nephrology Dialysis Transplantation, 19, 77-82. doi:10.1093/ndt/gfh1021
[12] Joyce, A.T., Iacoviello, J.M., Nag, S., et al. (2004) Endstage renal disease-associated managed care costs among patients with and without diabetes. Diabetes Care, 27, 2829-2835. doi:10.2337/diacare.27.12.2829
[13] Thorn, L.M., Forsblom, C., Fagerudd, J., et al. (2005) Metabolic syndrome in type 1 diabetes: Association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care, 28, 2019-2024. doi:10.2337/diacare.28.8.2019
[14] Littell, R.C. (2006) SAS for mixed models. SAS Institute, Cary.
[15] Srinivas, T.R. and Meier-Kriesche, H.U. (2008) Minimizing immunosuppression, an alternative approach to reducing side effects: Objectives and interim result. Clinical Journal of the American Society of Nephrology, 3, S101-S116. doi:10.2215/CJN.03510807
[16] Galliford, J. and Game, D.S. (2009) Modern renal transplantation: Present challenges and future prospects. Postgraduate Medical Journal, 85, 91-101. doi:10.1136/pgmj.2008.070862
[17] Steiner, R.W. and Awdishu, L. (2011) Steroids in kidney transplant patients. Seminars in Immunopathology, 33, 157-167. doi:10.1007/s00281-011-0259-7
[18] Denton, M.D., Magee, C.C. and Sayegh, M.H. (1999) Immunosuppressive strategies in transplantation. Lancet, 353, 1083-1091. doi:10.1016/S0140-6736(98)07493-5
[19] Jardine, A.G., Gaston, R.S., Fellstrom, B.C. and Holdaas, H. (2011) Prevention of cardiovascular disease in adult recipients of kidney transplants. Lancet, 378, 1419-1427. doi:10.1016/S0140-6736(11)61334-2
[20] Salmela, K.T. and Kyllonen, L.E. (2004) Two decades of experience with cyclosporine in renal transplantation in Helsinki. Transplantation Proceedings, 36, 94S-98S. doi:10.1016/j.transproceed.2004.01.036
[21] European Mycophenolate Mofetil Cooperative Study Group (1995) Anonymous placebo-controlled study of mycophenolate mofetil combined with cyclosporine and corticosteroids for prevention of acute rejection. Lancet, 345, 1321-1325.
[22] Clayton, P.A., McDonald, S.P., Chapman, J.R. and Chadban, S.J. (2012) Mycophenolate versus azathioprine for kidney transplantation: A 15-year follow-up of a randomized trial. Transplantation, 94, 152-158. doi:10.1097/TP.0b013e31825475a3
[23] Meier-Kriesche, H.U., Li, S., Gruessner, R.W., et al. (2006) Immunosuppression: Evolution in practice and trends, 1994-2004. American Journal of Transplantation, 6, 1111-1131. doi:10.1111/j.1600-6143.2006.01270.x
[24] Grinyo, J.M. and Cruzado, J.M. (2009) Mycophenolate mofetil and calcineurin-inhibitor reduction: Recent progress. American Journal of Transplantation, 9, 2447-2452. doi:10.1111/j.1600-6143.2009.02812.x
[25] Vincenti, F., Jensik, S.C., Filo, R.S., Miller, J. and Pirsch, J. (2002) A long-term comparison of tacrolimus (FK506) and cyclosporine in kidney transplantation: Evidence for improved allograft survival at five years. Transplantation, 73, 775-782. doi:10.1097/00007890-200203150-00021
[26] Liefeldt, L. and Budde, K. (2010) Risk factors for cardiovascular disease in renal transplant recipients and strategies to minimize risk. Transplant International, 23, 1191-1204.
[27] Isoniemi, H. and Jalanko, H. (2004) Selection of organ transplant drugs is increasing. Duodecim, 120, 1371-1378.
[28] Woodroffe, R., Yao, G.L., Meads, C., et al. (2005) Clinical and cost-effectiveness of newer immunosuppressive regimens in renal transplantation: A systematic review and modelling study. Health Technology Assessment, 9, 1-179.
[29] Levy, G.A. (2010) Progress in transplantation. Journal of Therapeutic Drug Monitoring, 32, 246-249. doi:10.1097/FTD.0b013e3181dca981
[30] Daratha, K.B., Short, R.A., Corbett, C.F., et al. (2012) Risks of subsequent hospitalization and death in patients with kidney disease. Clinical Journal of the American Society of Nephrology, 7, 409-416. doi:10.2215/CJN.05070511

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.