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The Economic Implications of Non-Adherence after Renal Transplantation

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Author Info

  • Irina Cleemput

    (Centre for Health Services and Nursing Research, Leuven, Belgium)

  • Katrien Kesteloot

    (University Hospitals Leuven, Leuven, Belgium, Centre for Health Services and Nursing Research, Leuven, Belgium)

  • Yves Vanrenterghem

    (Department of Nephrology, University Hospitals Leuven, Leuven, Belgium)

  • Sabina De Geest

    (Institute of Nursing Science, University of Basel, Basel, Switzerland)

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    Abstract

    Background: The economic impact of therapeutic non-adherence in chronic diseases has rarely been examined using qualitative standards for economic evaluation. This study illustrates the impact of non-adherence on the cost utility of renal transplantation versus haemodialysis from the societal perspective and examines the scope for adherence-enhancing interventions. Methods: Long-term costs and outcomes in adherent and non-adherent renal transplant patients were simulated in a Markov model. The cost (euros, year 2000 values) and outcome data that were imputed in the model were derived from a prospective study in renal transplantation candidates performed in 2002. Probabilities of adverse events, graft rejection, graft loss and death in adherent and non-adherent renal transplant patients were derived from literature. Results: Compared with dialysis, renal transplantation offers a better outcome in both adherent and non-adherent patients. Lifetime costs after transplantation in the adherent patient group are higher than lifetime dialysis costs and lifetime costs in the non-adherent patient group, mainly because adherent patients live longer after transplantation. Long-term outcomes after transplantation are better for adherent than for non-adherent patients. The mean cost per QALY gained in adherent patients relative to non-adherent patients was Conclusion: Compared with established healthcare interventions, such as haemodialysis, renal transplantation can be considered a cost-effective therapy for patients with end-stage renal disease, even if patients are non-adherent after transplantation. The low incremental cost per QALY calculated in this model for adherent renal transplant patients, suggests there may be scope

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    Bibliographic Info

    Article provided by Springer Healthcare | Adis in its journal PharmacoEconomics.

    Volume (Year): 22 (2004)
    Issue (Month): 18 ()
    Pages: 1217-1234
    Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
    Handle: RePEc:wkh:phecon:v:22:y:2004:i:18:p:1217-1234

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    Web page: http://pharmacoeconomics.adisonline.com/

    For corrections or technical questions regarding this item, or to correct its listing, contact: (Dave Dustin).

    Related research

    Keywords: Cost-utility; Dialysis; Immunosuppressants; Patient-compliance; Renal-failure; Renal-transplant-rejection;

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