A comparison of mycophenolate use in Australia and Northern Europe, and the impact on the pharmaceutical benefits scheme

Evaluating the utilisation and expenditure patterns of erythropoietin stimulating agents and immunosuppressants in Australian chronic kidney disease patients

Objectives

This study aimed to characterise utilisation and expenditure patterns associated with erythropoietin stimulating agents (ESAs) (darbepoetin alfa, epoetin alfa, epoetin beta, epoetin lambda and methoxy polyethylene glycol-epoetin beta) and immunosuppressants (mycophenolate, tacrolimus, ciclosporine, sirolimus and everolimus) in the Australian chronic kidney disease (CKD) population from 2010–2018.

Methods

Utilisation and expenditure data for each drug were obtained from the Pharmaceutical Benefit Scheme and Highly Specialised Drugs program. Utilisation data were provided a number of dispensing per year, which was then converted to the daily defined dose per 1000 population per day for each year. Temporal trends were then analysed.

Key findings

Over the study period, utilisation of methoxy polyethylene glycol-epoetin beta and epoetin lambda rose by 13.7 and 81.4-fold, respectively. Contrastingly, the utilisation of darbepoetin alfa, epoetin alfa and epoetin beta declined by 6%, 42% and 70%, respectively. In 2018, tacrolimus, sirolimus, everolimus and mycophenolate utilisation was up 126%, 16.9%, 125% and 182% respectively; conversely, ciclosporine utilisation dropped 19%. Total Australian expenditure on all ESAs examined remained stable at around AUD 128 million over the study period, while total Australian expenditure across all immunosuppressants increased 1.1-fold reaching just over AUD 98 million.

Conclusions

It appears that immunosuppressant utilisation and expenditure are rising as transplantation rates in Australia continue to increase. Conversely, ESA utilisation and expenditure remained relatively unchanged over the study period. This may be due to increasing concerns around the safety of ESAs offsetting the increasing number of people with CKD.