Cost-effectiveness of Medicare's coverage of immunosuppression medications for kidney transplant recipients

Kidney transplantation is the preferred method of treating patients with end-stage renal disease. Transplantation improves the quality of life of the transplant recipient and also results in reduced treatment costs owing to the cost difference between dialysis and the post-transplant immunosuppression medications. Currently, the USA's Medicare program covers immunosuppression medications for 3 years post-transplant for nonelderly, nondisabled patients, and there is currently a proposal to extend this coverage from 3 years to a lifetime for all transplant recipients. Upon expiration of the current 3-year benefit, some patients are unable to afford to pay for the medication on their own, resulting in graft loss and a return to dialysis. This article reviews studies that documented the improvements in long-term transplant outcomes attributable to previous coverage extensions of immunosuppression medications, from both 1-3 years posttransplant for all transplant recipients in 1993 and the coverage extension from 3 years to lifetime for elderly and disabled patients in the year 2000. In addition, previous studies of the potential cost-effectiveness of a lifetime immunosuppression benefit for all patients are discussed.