alence , cost and likely market

valence
Organ Transplantation
Transplanta tion

-Rohit Shrivastava
-M Sc Drug Development with bio-
business
th
Overview of presentation
• Introduction
• History
• Prevalence
• Treatment
• Cost of treatment
• Market
• Cost effectiveness of treatment
•
•
Introduction
What is organ transplant & rejection?

• Organ transplantation is the act of surgically removing an organ

from one person and placing it into another
person.
•
• The person who receives is recipient and person who donates is
a donor which could be dead or alive.
•
• Rejection is normal reaction of the body to a foreign object . In
response to foreign object body produces antibodies and
immune cells to attack the foreign object.
•
• Organs that are transplanted are kidneys, heart, liver, lungs,
pancreas, intestine, thymus and skin.
•
• Tissues that are transplanted are bones, tendons, cornea, heart
valves and Worldwide
veins. kidneys are the most commonly transplanted organs
History
Who was the pioneer of transplantation ?

• In 2nd century B.C, 1st organ transplantation surgery

was performed by Indian surgeon Sushrut who did
autograft for nose reconstruction.
•
• In 1900, artery transplant was performed by French
surgeon  Dr. Alexis Carrel with Charles Guthrie,
which earned Dr. Carrel Nobel prize in 1912 in
physiology.
•
•
•
•
• Acharya Sushrut
Types of organ transplants
• Write from wikipedia about china
Country Incidence of Kidney transplantation in
Prevalence
USA of2005organ
16,551 (293,655transplant
,405)
Canada 1,832 (32,507,874)
• 66,000 kidneys were transplanted in 2005 in 98
Brazilcountries (5.5 Bn)10,376 (184,101by
monitored ,109)WHO.
Venezuela 1,410 (25,017,387)
•
Sweden 506 (8,986,400)
• 21,000 liver and 6,000
UK 3,397 hearts
( were transplanted in
60,270,708 )
2005.
France 3,405 (60,424,213)
•
Germany 4,645 (82,424,609)
• In 2006,highest no 8,114
Russia of transplants
(143,974,059)were done in the
United States, France and Spain at 59–67 pmp.
Spain 2,270 (40,280,780)
•
China 73,208 (1,298,847,624)
• 9,078 kidney transplants
Japan from
7,176 (127 ,333cadavers
,002) and 3,048
India kidney transplants
USA 2001. 60,from
031 (living related donor in the
1,065,070,607)
Malaysia 1,325 (23,522,482)
•
Philippines 4,860 (86,241,697)
• Incidence Rate in USA
Australia 1,122accounts
(19,913,144for approx
) 1 in 17,741
or 0.01% of the total population.
Prevalence in UK
• In 2008-2009, 3,513 organ transplants
were carried out.
• A total of 2,536 patients received a
kidney, pancreas or combined
kidney/pancreas transplant.  
• 2,712 people had their sight restored
through a cornea transplant.
• Kidney transplantation prevalence rate of
738 pmp in the UK. Rates were lowest in
England at 731 pmp and highest in
Northern Ireland at 791 pmp.
• Incidence rates of kidney transplant in UK-
Scotland 115 pmp, Northern Ireland 116
Treatment of organ transplantation
rejection
• Treatment is aimed at inducing tolerance and
suppressing the immune system of the host.

Polyclonal anti-T-cell antibodies

mTOR inhibitors Anti-thymocyte globulin (ATG)
Sirolimus Anti-lymphocyte globulin (ALG)
Everolimus

Immuno
suppressive drugs

Calcineurin inhibitors
Cyclosporin Antibodies Monoclonal
Tacrolimus anti-IL-2α receptor antibodies
Basiliximab
Daclizumab

Corticosteroids
Anti - proliferativesAzathioprine
Prednisolone
Mycophenolic acid Hydrocortisone

Demi-Lee Brennan an Australian citizen whose body, after a liver transplant, changed blood type and
adopted the immune system of her donor.
Cost of treating organ transplant
rejection
• The use of immunosuppressant drugs in
transplant recipients was worth US$3
Treatment
billionin 2006,costand
in Asia
is in 2009
forecast to reach
DrugUS$4.3
regime billion by drugs
Immunosuppressive 2015. and their
Cost in US$cost in Euro
/ year
• Tacrolimus
in 2005
+ Azathioprine +
Drugs combination 1,500
Mean cost in €
Steriods
Tacrolimus
• Cyclosporine +
+/-MMF
In US, Depending +/- on
steriods
azathioprine 2,500
the specific
2,585 medication
CsAregime
+ MMF
Tacrolimus +/- immunosuppressive
+ steriods
azathioprine 4,616 drugs can cost on
4,000
CsA average
Sirolimus + MMF between
+ mycophenolate + US$11,000
steroids
mofetil 5,000
6,136 -US$25,000
per year
Everolimus
Tacolimus + +
for 3+years.
MMF
MMF steroids 6,000
7,212
• IL 2R antagonist
Steroids 2,000-3,000
50
ATG + 3 months prophylaxis 6,000-7,000
• Surgery cost in a public hospital 349
Antihypertensive agents
1,000
Lipid lowering drugs 294 (including surgical fees,
• Cost of renal transplant inmedications, US is more than
consumables and
$100,000 whereas 1 year cost hospital
inpatient of dialysis
charge)
costs $71,000
•
Cost effectiveness of treatment
• Pharmacoecomics study – 2009
 1200 additional kidney transplants could be done
each year, this would save a total of £500 million
pounds over the next decade.
•
• Use of new antibodies - Basixlimab.
•
• Transplantation cost £ 46 000
• Dialysis cost £ 25 000
• annual treatment expenses £ 7000 each year
 after transplantation
 Savings £ 18,000 per patient


 Total savings of NHS in 2008-09 £ 50.3 Mn expected

saving in 2009-10 £ 512Mn.
References

• Clinical and cost-effectiveness of newer

immunosuppressive regimens in renal
transplantation. Health Technology Assessment
2005; Vol. 9: No. 21
• M.A. Gentil, M. López, F. González-Roncero, C.
Cantarell, and J. Marco .Cost of Renal Transplant
Maintenance Immunosuppression: Effect of
Control of Vascular Risk Factors.
Transplantation Proceedings, 37, 1464–1465
(2005)
• Assessing the Cost of Dispensing
Immunosuppressive Drugs to Medicare
Transplant Recipients – An Update. April 15,
2007. The Lewin Group, Inc.
THANK YOU