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Randomized Controlled Trial
. 2024 Nov 27;39(12):2058-2066.
doi: 10.1093/ndt/gfae084.

Rituximab or cyclosporine A for the treatment of membranous nephropathy: economic evaluation of the MENTOR trial

Matthew Kadatz  1   2 , Scott Klarenbach  3 , Helen So  3 , Fernando C Fervenza  4 , Daniel C Cattran  5 , Sean J Barbour  1   6 ; MENTOR Study Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Rituximab or cyclosporine A for the treatment of membranous nephropathy: economic evaluation of the MENTOR trial

Matthew Kadatz et al. Nephrol Dial Transplant. .

Abstract

Background and hypothesis: The MENTOR trial (MEmbranous Nephropathy Trial Of Rituximab) showed that rituximab was noninferior to cyclosporine in inducing complete or partial remission of proteinuria and was superior in maintaining proteinuria remission. However, the cost of rituximab may prohibit first-line use for some patients and health-care payers.

Methods: A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of rituximab compared with cyclosporine for the treatment membranous nephropathy from the perspective of a health-care payer with a lifetime time horizon. The model was informed by data from the MENTOR trial where possible; additional parameters including cost and utility inputs were obtained from the literature. Sensitivity analyses were performed to evaluate the impact of reduced-cost biosimilar rituximab.

Results: Rituximab for the treatment of membranous nephropathy was cost effective (assuming a willingness-to-pay threshold of $50 000 per quality-adjusted life year (QALY) gained; in $US 2021) compared with cyclosporine, with an ICER of $8373/QALY over a lifetime time horizon. The incremental cost of rituximab therapy was $28 007 with an additional 3.34 QALYs compared with cyclosporine. Lower cost of rituximab biosimilars resulted in a more favorable ICER, and in some cases resulted in rituximab being dominant (lower cost and great benefit) compared to cyclosporine.

Conclusions: Despite the greater cost of rituximab, it may be a cost-effective option for the treatment of membranous nephropathy when compared with cyclosporine. The cost-effectiveness of rituximab is further improved with the use of less expensive biosimilars.

Keywords: cost-effectiveness; cyclosporine; economic evaluation; membranous nephropathy; rituximab.

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Conflict of interest statement

Sources of support: M.K. receives financial support from the Michael Smith health Research BC Health Professional Investigator Award. S.K. is supported by the Kidney Health Research Chair and the Division of Nephrology at the University of Alberta. S.K. is Director of the Real World Evidence Consortium, and Alberta Drug and Therapeutic Evaluation Consortium (Universities of Alberta, Calgary, and Institute of Health Economics); these entities receive funding from decision-makers and industry to conduct research. All research funding is made to the academic institution; investigator retains full rights of academic freedom and right to publish. This relationship is not related to the current work.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Diagram of base-case Markov model.
Figure 2:
Figure 2:
Tornado diagram of results of one-way sensitivity analyses from Markov model. This graph demonstrates the range of ICERs given the plausible ranges for each input variable. The estimated value (EV) of the ICER from the overall deterministic Markov model is shown on the graph with a dashed line. Prob., probability.
Figure 3:
Figure 3:
Cost-effectiveness acceptability curve of the results of the probabilistic sensitivity analysis for the incremental cost-effectiveness of rituximab (RTX) compared with cyclosporine (CsA) for the treatment of primary membranous nephropathy. This graph shows the proportion of iterations where rituximab (circles, solid line) and cyclosporine (triangles, dashed line) were cost effective according to varying willingness-to-pay thresholds. See the Supplementary Figure for these results presented as a scatter plot on the cost-effectiveness plane.
Figure 4:
Figure 4:
ICER as a function of the cost of 1 g of rituximab. For reference, the ICER assuming costs of generic biosimilars in Germany and the USA are labeled. Costs of generic biosimilars in Canada and the UK are not shown as these resulted in a dominant ICER where treatment with rituximab was less expensive than treatment with cyclosporine and more effective.
See this image and copyright information in PMC

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