Penny wise and pound foolish: now in the NEJM

It's truer than ever that in the United States we have a foolish Medicare policy of only paying for three years of anti-rejection drugs following a kidney transplant, even though Medicare covers the larger costs of dialysis and/or re-transplantation.

And now it's peer reviewed: the New England Journal of Medicine picks up the story in its February 1 2012 issue: "Penny Wise, Pound Foolish? Coverage Limits on Immunosuppression after Kidney Transplantation" by Gill and Tonelli.

"As a treatment for end-stage renal disease (ESRD), kidney transplantation is superior to dialysis for improving patient survival rates and quality of life. Its long-term success, however, requires ongoing treatment with immunosuppressive drugs. Ironically, although many of the pivotal discoveries related to immunosuppression have been made in the United States, U.S. kidney-transplant recipients do not benefit from a coherent funding policy for these drugs, and thousands of such patients are therefore at risk for allograft failure and premature death. Ensuring lifetime access to these medications for all Americans with kidney transplants would save lives as well as reduce the total cost of treating patients with ESRD.
...
"Premature transplant failure is the fifth leading cause of initiation of dialysis in the United States. Unfortunately, approximately 25% of patients whose transplants fail die within 2 years after returning to dialysis. This outcome is worse than the 2-year mortality among patients with a functioning transplant from a deceased donor (6%) and still worse than that among age-matched dialysis patients who have never received a transplant (20%).
A second transplant is the best treatment option for a patient whose transplant has failed, but the opportunities for repeat transplantation are much more limited than those for initial transplantation. Candidates for repeat transplantation account for about 20% of patients on the waiting list but (because of sensitization from their failed allograft) receive only 12% of the deceased-donor kidneys transplanted annually in the United States."

Here's my earlier blog post on the subject:

Tuesday, September 15, 2009

Penny wise and pound foolish on kidneys and antirejection drugs

HT: Scott Kominers