Economic Evaluation of Rituximab Versus Corticosteroid-Cyclophosphamide or Cyclosporine in Patients With Membranous Nephropathy in Republic of Korea

Background: Cyclic corticosteroid-cyclophosphamide or cyclosporine is a well-known membranous nephropathy (MN) treatment but has high risks of adverse drug reactions (ADRs). Rituximab has a non-inferior effect compared to previous treatments, with fewer ADRs. However, the high cost of rituximab is a pharmacoeconomic disincentive. Methods: We conducted a cost-minimisation analysis to evaluate the relative and absolute costs of rituximab versus corticosteroid-cyclophosphamide or cyclosporine in patients with MN over 2 years using a decision-tree model based on ADRs from two pivotal trials (RI-CYCLO and MENTOR). We included costs of medication, time, transportation, and ADRs. Deterministic sensitivity analysis and threshold analysis were performed to assess the uncertainty of the model input parameters and estimate the appropriate price of rituximab. Results: The total expected cost for rituximab was $4132, and $2684 for the comparators, with an expected incremental cost of $1448. Despite a 2.8 times higher medication cost, rituximab reduced ADR costs by 96.3% ($223), time costs by 31.1% ($280), and transportation costs by 46.8% ($180). A 46.9% price reduction of rituximab would make it an economically favourable option for treating MN compared to comparators. Conclusions: If the price of rituximab is reduced, it can be a good alternative to corticosteroid-cyclophosphamide or cyclosporine for MN in the Republic of Korea.