الفهرس 
A Pharmacoeconomic Study Comparing the Use of Mycophenolate Mofetil or Cyclophosphamide as Induction Therapy in Lupus Nephritis Patients in Egypt
Table of ContentsOnly 14 pages are availabe for public view
 |  | from | 170 |  |  |
| | | from | 170 | | |
Abstract
Background
Lupus nephritis (LN) is a major and serious complication of systemic lupus erythematosus (SLE) and is associated with increased morbidity and mortality. LN treatment consists of two phases: The first phase is called induction therapy, in which patients are given anti-inflammatories and immunosuppressive drugs. Anti-inflammatories reduce renal inflammation and promote tissue healing, while the immunosuppressive agent interferes with autoimmune pathways to prevent any potential complex formation of the kidneys that could lead to acute renal flare-ups.
The induction phase usually lasts 3 to 6 months and is followed by maintenance therapy. It is less intense but can last for years and is given to prevent relapses. The difference in the cost of induction therapy for LN, including cyclophosphamide (CYC) and mycophenolate mofetil (MMF), has long become an important and realistic issue, particularly in developing countries.
Aims of the study
This study aims to estimate and compare the costs and outcomes of CYC and MMF in order to better allocate resources to mitigate the burden on the Egyptian health care system.
Patients and Methods
A prospective cohort study was conducted in Kasr Al-Ainy Hospital between 2018 and 2020. A monthly follow-up of 122 patients with LN was conducted during the 1 -year study period. In addition, all expenses and costs associated with CYC and MMF induction regimens were examined. Furthermore, a prospective assessment of reported changes in health-related quality of life using SF-36 was included in the study.
Data was collected from hospital records at baseline before the induction phase and at each patient’s 12-month return visit. Patients were interviewed monthly during physician visits to identify any potential adverse events. Hospital records and patient interviews were used to identify current prescribed and nonprescribed medications, patient clinical status updates, and data related to hospital admission.
Renal remission was the primary efficacy outcome measure for induction therapy. Secondary outcomes included the proportion of patients who reported adverse events in both groups throughout the study period. Furthermore, a cost-minimization analysis was performed in which all expenditures and healthcare costs associated with both regimens were examined from the governmental perspective.
Results:
There was no statistically significant difference in treatment response at 6 and 12 months (RR 0.6 [0.26;1.43] and 0.8 [0.27;2.33]) respectively, as well as the incidence of infection episodes between MMF and CYC group (71.4% vs 70.45%, P > 0.05). There were no significant differences in gastrointestinal adverse events except for diarrhea between the two groups. The average total direct medical expense per patient for 12 months in the MMF group was 36663 LE. (1991.47 $), nearly one and a half times more than treatment with CYC. Quality of life was reported for eighty-five patients who accepted to participate and responded at the end of induction therapy with partial or complete remission and then started maintenance therapy. None of the baseline scores were significantly different between the two groups after 12 months.
Conclusion:
Our results demonstrated that the use of intravenous (IV) CYC in patients with LN saved approximately 900 $ per patient, with no significant difference in efficacy, adverse effects, and quality of life, suggesting that cyclophosphamide may be an attractive treatment option in developing countries. These findings suggest that healthcare decision-makers in developing countries should consider adopting IV CYC as an induction therapy while adhering to dosing recommendations.