Extending Medicare Coverage for Immunosuppressive Drugs Cost-Effective

Medicare coverage for kidney transplant recipients ceases 36 months following transplantation. The 36-month removal policy cancels coverage for the immunosuppressive medications that are essential to prevent rejection and maintain transplant function.

There are no contemporary data regarding the economic impact of extending Medicare coverage for the duration of transplant survival using mean cost of immunosuppressive medications in the era of generic equivalents. Many transplant recipients currently continue to receive Medicare coverage beyond the 36 months cutoff due to medical disability benefits.

Matthew J. Kadatz, MD, and colleagues used a Markov model to determine the incremental cost and effectiveness of extending Medicare coverage for immunosuppressive drugs for the duration of transplant survival versus the current policy from the perspective of the Medicare payer. Results of the analysis were reported during an oral presentation at Kidney Week 2019 in a presentation titled Economic Evaluation of Lifelong Medicare Immunosuppressive Drug Coverage for Kidney Transplant Recipients.

The analysis used contemporary mean costs of immunosuppressive medications and incorporated assessment of continuation of Medicare coverage beyond the current 36 months in patients who have been designated medically disabled. Data from a cohort of privately insured recipients derived using multivariable survival analysis were used to estimate the expected graft survival of extending immunosuppressive drug coverage.

Results of the analysis demonstrated that extension of immunosuppression coverage under Medicare for kidney transplant recipients led to lower costs of approximately $3163 as well as 0.18 additional quality adjusted life years. Following the reduction of the improvement in transplant survival associated with extended immunosuppressive coverage to 50% of that seen in privately insured patients, the strategy of extending drug coverage had an incremental cost-utility ratio of $77,613 per quality adjusted life year gained.

“Extending immunosuppressive drug coverage under Medicare from the current 36 months to the duration of transplant survival will result in better patient outcomes and cost savings, and remains cost-effective if only a fraction of anticipated benefit is realized,” the researchers said.

Source: Kadatz MJ, Gill JS, Formica RN, Klarenbach S. Economic evaluation of lifelong Medicare immunosuppressive drug coverage for kidney transplant recipients. Abstract of an oral presentation at the American Society of Nephrology Kidney Week 2019 (Abstract TH-OR128), November 7, 2019, Washington, DC.