Data reported here were supplied by the United States Renal Data System (USRDS). Interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the U.S. Government.
Cost-Effectiveness of Extending Medicare Coverage of Immunosuppressive Medications to the Life of a Kidney Transplant
Article first published online: 2 AUG 2004
American Journal of Transplantation
Volume 4, Issue 10, pages 1703–1708, October 2004
How to Cite
Yen, E. F., Hardinger, K., Brennan, D. C., Woodward, R. S., Desai, N. M., Crippin, J. S., Gage, B. F. and Schnitzler, M. A. (2004), Cost-Effectiveness of Extending Medicare Coverage of Immunosuppressive Medications to the Life of a Kidney Transplant. American Journal of Transplantation, 4: 1703–1708. doi: 10.1111/j.1600-6143.2004.00565.x
- Issue published online: 2 AUG 2004
- Article first published online: 2 AUG 2004
- Received 25 March 2004, revised and accepted for publication 4 June 2004
- kidney transplantation;
- public policy;
- renal failure
Unless they maintain Medicare status through disability or age, kidney transplant recipients lose their Medicare coverage of immunosuppression 3 years after transplantation. A significant transplant survival advantage has previously been demonstrated by the extension of Medicare immunosuppressive medication coverage from 1 year to 3 years, which occurred between 1993 and 1995.
The United States Renal Data System (USRDS) was analyzed for recipients of kidney transplants from 1995 to 1999. Using a Markov model, we estimated survival and costs of the current system of 3-year coverage compared with lifetime immunosuppression coverage. Results were calculated from the perspectives of society and Medicare.
Extension of immunosuppression coverage produced an expected improvement from 38.6% to 47.6% in graft survival and from 55.4% to 61.8% in patient survival.
The annualized expected savings to society from lifetime coverage was $136 million assuming current rates of transplantation. Medicare would break-even compared with current coverage if the fraction of patients using extended coverage was <32%. The extension would be cost-effective to Medicare if this fraction was <91%.
Extended Medicare immunosuppression coverage to the life of a kidney transplant should result in better transplant and economic outcomes, and should be considered by policy makers.