Different drugs, same outcomes. Different drugs, different outcomes. Which is it? At first glance these two studies published in this issue of Transplantation offer starkly conflicting findings that have important clinical and policy implications. Antimetabolites, either azathioprine or mycophenolate are used for almost all kidney transplant recipients worldwide. What is certain is the price differential. The yearly cost of azathioprine is approximately A$600, compared with A$6000 for mycophenolate, a 10-fold difference. The newer drug costs substantially more than the older drug is expected. Almost all newer drugs are more expensive than the older drugs which they are designed to replace, but policy makers typically accept such cost increments provided that there are concomitant health gains resulting in an acceptable cost-effectiveness ratio. It is a simple question which should have a simple answer. What are the relative benefits and harms of mycophenolate compared with azathioprine for death, graft loss, infection, and malignancy?
- cost benefit analysis
- kidney transplantation