Cost-Utility Analysis of Mycophenolate Mofetil versus Azathioprine Based Regimens for Maintenance Therapy of Proliferative Lupus Nephritis

Abstract EN

Background/Aims.

We aimed to examine the cost-effectiveness of mycophenolate mofetil (MMF) and azathioprine (AZA) as maintenance therapy for patients with Class III and Class IV lupus nephritis (LN), from a United States (US) perspective.

Methods.

Using a Markov model, we conducted a cost-utility analysis from a societal perspective over a lifetime horizon.

The modeled population comprised patients with proliferative LN who received maintenance therapy with MMF (2 gm/day) versus AZA (150 mg/day) for 3 years.

Risk estimates of clinical events were based on a Cochrane meta-analysis while costs and utilities were retrieved from other published sources.

Outcome measures included costs, quality-adjusted life-years (QALY), incremental cost-effectiveness ratios (ICER), and net monetary benefit.

Results.

The base-case model showed that, compared with AZA strategy, the ICER for MMF was $2,630,592/QALY at 3 years.

Over the patients’ lifetime, however, the ICER of MMF compared to AZA was $6,454/QALY.

Overall, the ICER results from various sensitivity and subgroup analyses did not alter the conclusions of the model simulation.

Conclusions.

In the short term, an AZA-based regimen confers greater value than MMF for the maintenance therapy of proliferative LN.

From a lifelong perspective, however, MMF is cost-effective compared to AZA.