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. 2023 Nov 29;24(1):351.
doi: 10.1186/s12882-023-03392-y.

Impact of compliance to oral cysteamine treatment on the costs of Kidney failure in patients with nephropathic cystinosis in the United Kingdom

Seun Lashilola  1 , Weiwei Xu  2 , Khashayar Azimpour  3 , Michael McCarthy  4 , Sara Carlot  5 , David Game  6 , Judith van der Voort  7
Affiliations

Impact of compliance to oral cysteamine treatment on the costs of Kidney failure in patients with nephropathic cystinosis in the United Kingdom

Seun Lashilola et al. BMC Nephrol. .

Abstract

Background: Nephropathic Cystinosis (NC), a rare disease characterised by intra-lysosomal accumulation of cystine, results in progressive kidney failure (KF). Compliance to lifelong oral cysteamine, the only therapy, is often compromised. The relationship between compliance and costs of NC has not been previously formally assessed. The present study evaluates the impact of compliance on lifetime (direct) costs of treating KF in NC patients in the United Kingdom.

Methods: A three-state (KF-free, post-KF, death) partitioned survival model was developed for hypothetical 'Good Compliance' (GC) and 'Poor Compliance' (PC) cohorts. Survival in the KF-free state was determined by a published regression function of composite compliance score (CCS). The CCS is a summation of annual compliance scores (ACS) over treatment duration prior to KF. ACSs are indexed on annual (average) leukocyte cystine levels (LCL). The Poor Compliance cohort was defined to reflect NC patients in a previous study with a mean LCL of 2.35 nmols nmol half-cystine/mg protein over the study period - and an estimated mean ACS of 1.64 over a 13.4 year treatment duration. The Good Compliance cohort was assumed to have an ACS of 2.25 for 21 years. Major KF costs were evaluated - i.e., dialysis, kidney transplants, and subsequent monitoring.

Results: The mean CCS was 47 for the GC and 22 for the PC cohort respectively, corresponding to estimated lifetime KF costs of £92,370 and £117,830 respectively - i.e., a cost saving of £25,460/patient, or £1,005/patient for every 1-unit improvement in CCS.

Conclusion: This analysis indicates that lifetime costs of KF in NC can be reduced through improved treatment compliance with oral cysteamine.

Keywords: Adherence; Delayed-release Cysteamine Bitartrate; Kidney Failure; Nephropathic cystinosis; Treatment compliance; United Kingdom.

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Conflict of interest statement

KA, and SC are employees of Chiesi Farmaceutici. SL and WX are employees of IQVIA, that received consulting fees from Chiesi Farmaceutici. At the time of writing, MM was an employee of MAP Patient Access who received consulting fees from Chiesi Farmaceutici. DG and JV are nephrologists at Guy’s Hospital in London, and University Hospital of Wales, respectively; they received consulting fees from Chiesi Farmaceutici.

Figures

Fig. 1
Fig. 1
Three primary health states of partitioned survival model. KF: Kidney Failure
See this image and copyright information in PMC

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