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Abstract: PO1652

Economic Evaluation of the MENTOR Trial Comparing Rituximab and Cyclosporine for the Treatment of Membranous Nephropathy (MN)

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kadatz, Matthew J., The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  • Klarenbach, Scott, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • So, Helen, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
  • Fervenza, Fernando C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cattran, Daniel C., University of Toronto, Toronto, Ontario, Canada
  • Barbour, Sean, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada

Group or Team Name

  • On behalf of the MENTOR trial investigators
Background

The MENTOR trial (MEmbranous Nephropathy Trial Of Rituximab) showed that rituximab (RTX) was noninferior to cyclosporine (CSA) in inducing complete or partial remission of proteinuria and was superior in maintaining proteinuria remission. However, the cost of RTX is high and it’s cost-effectiveness has not been determined.

Methods

A Markov model (Fig 1) was used to determine the incremental cost-effectiveness ratio (ICER) of RTX compared with CSA for the treatment MN from the perspective of a health care payer with a life-time time horizon ($2020 USD). The model outcomes were informed by data from the MENTOR trial and previously published literature. Cost and utility inputs were obtained from the literature.

Results

Based on 1,000 simulations, the mean additional cost of RTX therapy for MN compared with CSA was $168,064 with an improvement in utility of 6.70 QALYs (Fig 2). RTX was cost-effective (assuming a willingness-to-pay threshold of $50,000 / QALY) compared with cyclosporine, with an ICER of $25,071 per additional quality adjusted life year (QALY) over a lifetime time horizon (45 years).

Conclusion

While the initial cost of RTX is high, RTX is a cost-effective option (assuming willingness to pay thresholds of $50,000 or greater) for the treatment of MN when compared with the alternative of CSA. The cost-effectiveness will be further improved with the use of less expensive biosimilars.