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. 2023 Apr 12;23(1):361.
doi: 10.1186/s12913-023-09365-z.

Immunosuppressive therapy for progressive idiopathic membranous nephropathy: a cost-effectiveness analysis in China

Wanyi Xu  1 , Zhiqi Zhang  2 , Dandan Li  1 , Wendi Dai  3 , Chen Pan  1 , Mingxing Guo  1 , Ying Zhao  1 , Xiangli Cui  4
Affiliations

Immunosuppressive therapy for progressive idiopathic membranous nephropathy: a cost-effectiveness analysis in China

Wanyi Xu et al. BMC Health Serv Res. .

Abstract

Background: This study aims to evaluate the cost-effectiveness of immunosuppressive therapy for patients with progressive idiopathic membranous nephropathy (IMN) from the Chinese healthcare system perspective.

Methods: To estimate the cost-effectiveness of four regimens namely cyclophosphamide, cyclosporine, rituximab and tacrolimus-rituximab in treatment of IMN recommended by the updated Kidney Disease: Improving Global Outcomes (KDIGO) guideline 2021, a Markov model with five discrete states (active disease, remission, dialysis, kidney transplant and death) based on IMN patients aged 50 or above over a 30-years time horizon was constructed. Total costs were imputed from the Chinese healthcare system perspective, and health outcomes were converted into quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was used to describe the results. The willingness-to-pay (WTP) threshold was set at $12,044 (China's 2021 Gross Domestic Product per capita). Sensitivity analyses were performed to test the uncertainties of the results.

Result: Compared with cyclophosphamide, both cyclosporine (incremental cost $28,337.09, incremental QALY-1.63) and tacrolimus-rituximab (incremental cost $28,324.13, incremental QALY -0.46) were considered at strictly dominated for their negative values in QALYs, and the ICER value of rituximab was positive (incremental cost $9,162.19, incremental QALY 0.44). Since the ICER of rituximab exceeds the pre-determined threshold, cyclophosphamide was likely to be the best choice for the treatment of IMN within the acceptable threshold range. The results of the sensitivity analysis revealed that the model outcome was mostly affected by the probability of remission in rituximab. In a probabilistic sensitivity analysis, cyclophosphamide had 62.4% probability of being cost-effective compared with other regimens when the WTP was $12,044 per QALY. When WTP exceeded $18,300, rituximab was more cost-effective than cyclophosphamide.

Conclusion: Compared with cyclosporine, rituximab and tacrolimus-rituximab, our model results indicated that cyclophosphamide represented the most cost-effective regimen for patients with progressive IMN in China.

Keywords: Cost-effectiveness; Idiopathic membranous nephropathy; Immunosuppressive therapy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Markov structural model of health states with disease progression
Fig. 2
Fig. 2
Tornado analysis (ICER) at a willingness-to-pay threshold of $12,044
Fig. 3
Fig. 3
Cost-effectiveness acceptability curve for four drugs
Fig. 4
Fig. 4
Incremental cost-effectiveness scatter plot of probabilistic sensitivity analysis (the slope of WTP $12,044/QALY)
See this image and copyright information in PMC

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