Clinical and economic impact of immunosuppressive therapy in the treatment and management of adult renal and liver transplantation

Muduma, Gorden (2018) Clinical and economic impact of immunosuppressive therapy in the treatment and management of adult renal and liver transplantation. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

World wide the number of people living with renal or liver transplants is growing due to the increase in prevalence of end stage renal disease and end stage liver disease which neccesitate transplantation. Life long immunosuppression is needed for transplant recipients to prevent graft rejection and or death. Whilst the immunosuppression can significantly improve patient and graft survival it comes at a cost to the healthcare services. It is therefore, important that the immunosuppression used in clinical practice is supported by both clinical and cost effectiveness evidence. The aim of this thesis is to evaluate the clinical and economic impact of immunosuppression therapy in the treatment and management of adult renal and liver transplant recipients based on author's published research. Healthcare systems across the world are now placing greater importance on optimising their finite resources in demonstrating clinical and cost effectiveness of treatments. A number of health authorities such as the United Kingdom(UK), National Institute of Health and Care Excellence (NICE) have implemented methodologies guiding resource allocation decisions through formal health technology assessment (HTA). Clinical and economic evidence generation and synthesis reflecting current clinical practice can help to inform HTA decisions which impacts patients access to medicines. This thesis presents and critically appraise eight peer reviewed publications to demonstrate the clinical and economic impact of immunosuppression therapy in adult renal and liver transplant recipients. Each publication updated and or contributed to new knowledge in the field. The thesis highlights how the eight publications formed a cohesive body of evidence which can be used by policy makers to inform the development and or updating of clinical and reimbursemsent guidelines which ultimately impact product adoption and patient accesss to immunosuppressive medicines. The clinical effectiveness of immunosuppression was explored through systematic literature reviews, meta-analysis and indirect treatment comparison to establish the efficacy and safety of the different interventions used in post renal and liver transplant. The outputs from the clinical effectiveness together with relevant data from other sources was used to develop economic models to assess the cost effectiveness of immunosuppression. An assessment of the budget impact of immunosuppression in post renal transplant was also examined. Based on this research prolonged release tacrolimus was shown to be clinically and economically more effective than immediate release tacrolimus the current standard of care. The thesis concluded that tacrolimus remains the cornerstone of renal and liver post transplant immunosuppression while also highlighting the strengths and limitations of the current research and making recommendations for future studies.