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Cost-Effectiveness of Administering Rituximab for Steroid-Dependent Nephrotic Syndrome and Frequently Relapsing Nephrotic Syndrome: A Preliminary Study in Japan

View Article: PubMed Central - PubMed

ABSTRACT

With regard to the use of rituximab for patients with steroid-dependent nephrotic syndrome and frequently relapsing nephrotic syndrome, not only has the regimen not been clinically verified but also there is a lack of health economics evidence. Therefore, we conducted a prospective clinical study on 30 patients before (with steroids and immunosuppressants) and after introducing rituximab therapy. Relapse rates and total invoiced medical expenses were selected as the primary endpoints for treatment effectiveness and treatment costs, respectively. As secondary endpoints, cost-effectiveness was compared before and after administering rituximab in relation to previous pharmacotherapy. The observation period was 24 months before and after the initiation of rituximab. We showed that there was a statistically significant improvement in the relapse rate from a mean of 4.30 events before administration to a mean of 0.27 events after administration and that there was a significantly better prognosis in the cumulative avoidance of relapse rate by Kaplan–Meier analysis (p < 0.01). Finally, the total medical costs decreased from 2,923 USD to 1,280 USD per month, and the pre–post cost-effectiveness was confirmed as dominant. We, therefore, conclude that treatment with rituximab was possibly superior to previous pharmacological treatments from a health economics perspective.

No MeSH data available.


Displacement (6-month cumulative) of mean medical costs (general) after administering rituximab.Medical costs (of adding rituximab) also tended to decrease during the treatment period (comparison of initial period of administration and 1.5 years later; p < 0.01). Error bars denote SD. Statistical significance of population mean difference was analyzed using t-test.
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f3: Displacement (6-month cumulative) of mean medical costs (general) after administering rituximab.Medical costs (of adding rituximab) also tended to decrease during the treatment period (comparison of initial period of administration and 1.5 years later; p < 0.01). Error bars denote SD. Statistical significance of population mean difference was analyzed using t-test.

Mentions: The tendency of medical costs to decrease before and after starting rituximab did not show statistical significance for either general case or 17-month case. By contrast, the medical costs after adding rituximab showed a clear trend toward improvement, moving from 147,047 ± 32,054 points per 6 months to 89,676 ± 10,524 points per 6 months: as shown in Fig. 3, this was 14,221 USD per 6 months at the start of the administration period, and 8,673 USD per 6 months after 18 months (p < 0.01). The total medical cost also decreased with the reduction in urinary protein levels (changes in urinary protein level >4 vs. changes in urinary protein level = 0; p < 0.05, Fig. 4).


Cost-Effectiveness of Administering Rituximab for Steroid-Dependent Nephrotic Syndrome and Frequently Relapsing Nephrotic Syndrome: A Preliminary Study in Japan
Displacement (6-month cumulative) of mean medical costs (general) after administering rituximab.Medical costs (of adding rituximab) also tended to decrease during the treatment period (comparison of initial period of administration and 1.5 years later; p < 0.01). Error bars denote SD. Statistical significance of population mean difference was analyzed using t-test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384079&req=5

f3: Displacement (6-month cumulative) of mean medical costs (general) after administering rituximab.Medical costs (of adding rituximab) also tended to decrease during the treatment period (comparison of initial period of administration and 1.5 years later; p < 0.01). Error bars denote SD. Statistical significance of population mean difference was analyzed using t-test.
Mentions: The tendency of medical costs to decrease before and after starting rituximab did not show statistical significance for either general case or 17-month case. By contrast, the medical costs after adding rituximab showed a clear trend toward improvement, moving from 147,047 ± 32,054 points per 6 months to 89,676 ± 10,524 points per 6 months: as shown in Fig. 3, this was 14,221 USD per 6 months at the start of the administration period, and 8,673 USD per 6 months after 18 months (p < 0.01). The total medical cost also decreased with the reduction in urinary protein levels (changes in urinary protein level >4 vs. changes in urinary protein level = 0; p < 0.05, Fig. 4).

View Article: PubMed Central - PubMed

ABSTRACT

With regard to the use of rituximab for patients with steroid-dependent nephrotic syndrome and frequently relapsing nephrotic syndrome, not only has the regimen not been clinically verified but also there is a lack of health economics evidence. Therefore, we conducted a prospective clinical study on 30 patients before (with steroids and immunosuppressants) and after introducing rituximab therapy. Relapse rates and total invoiced medical expenses were selected as the primary endpoints for treatment effectiveness and treatment costs, respectively. As secondary endpoints, cost-effectiveness was compared before and after administering rituximab in relation to previous pharmacotherapy. The observation period was 24 months before and after the initiation of rituximab. We showed that there was a statistically significant improvement in the relapse rate from a mean of 4.30 events before administration to a mean of 0.27 events after administration and that there was a significantly better prognosis in the cumulative avoidance of relapse rate by Kaplan&ndash;Meier analysis (p&thinsp;&lt;&thinsp;0.01). Finally, the total medical costs decreased from 2,923&thinsp;USD to 1,280&thinsp;USD per month, and the pre&ndash;post cost-effectiveness was confirmed as dominant. We, therefore, conclude that treatment with rituximab was possibly superior to previous pharmacological treatments from a health economics perspective.

No MeSH data available.