Membranous nephropathy has traditionally been treated with the drug cyclosporine – yet new evidence suggests a more expensive drug, called rituximab, is a better bargain when long-term costs and patient health are taken into account. As a result of these findings, BC Renal, which plans and coordinates health-care services for British Columbians with kidney disease, has changed its funding structure to provide rituximab as a first-line treatment for membranous nephropathy.
Membranous nephropathy occurs when a person’s immune system causes harmful inflammation in the kidneys. For many years, cyclosporine has been the primary drug chosen to treat the condition. However, this treatment option has several downsides, including the fact that membranous nephropathy can sometimes return once cyclosporine has been stopped, and patients require close monitoring while on the medication.
Previous studies have shown the relatively new drug, rituximab, can be more effective, but because of its higher cost, it hasn’t been widely prescribed.
“BC Renal used to consider cyclosporine as a first-line therapy for membranous nephropathy, and rituximab could only be given if a patient didn’t respond to all other options,” explains Dr. Sean Barbour, a researcher with the University of British Columbia’s Division of Nephrology.
However, Barbour and his colleagues, including Dr. Matthew Kadatz who is also a researcher with UBC’s Division of Nephrology, wondered if cyclosporine truly was cheaper, given how cyclosporine often involves additional costs to monitor patients via bloodwork, and sometimes doesn’t keep membranous nephropathy under control as effectively.
The researchers conducted a cost analysis of the two drugs, taking into consideration the pros and cons of each one. The results, published in Nephrology Dialysis Transplant, show that rituximab was more cost effective in the long-term.
“This was a huge paradigm shift,” Barbour says, “Because although the immediate drug costs might be less for cyclosporine, it was actually going to end up costing BC Renal more to fund it as a first-line therapy in the long term.”
The results of the study show the extra investment in rituximab yields major benefits for patients. For example, using rituximab instead of cyclosporine for one year cost the health-care system approximately $8,000 per patient and gained the patients one year of healthy life they may not have had with cyclosporine.
Notably, there are many generic versions of rituximab available in Canada now, enabling even more cost savings. If generic rituximab is used to treat membranous nephropathy, it may actually cost the health-care system less than using cyclosporine and still gain healthy life years for patients.
