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The following is a summary of “Rituximab or cyclosporine a for the treatment of membranous nephropathy: Economic evaluation of the MENTOR trial,” published in the April 2024 issue of Nephrology by Kadatz et al.

In the MENTOR (MEmbranous Nephropathy Trial of Rituximab) trial, rituximab was described as good as cyclosporine for treating complete or partial remission of proteinuria in membranous nephropathy. However, rituximab was considered better for maintaining proteinuria remission.

Researchers conducted a retrospective study to verify whether rituximab’s high cost would stop its first-line use for some patients or healthcare payers. 

They used a Markov model to determine the Incremental cost-effectiveness ratio (ICER) of rituximab compared to cyclosporine for treating membranous nephropathy from the payer’s perspective with a life-time horizon. Data from the MENTOR trial and other sources were also analyzed, with sensitivity analysis being performed to evaluate the impact of reduced-cost biosimilar rituximab. 

The results showed that rituximab was cost-effective, assuming a willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY) for treating membranous nephropathy, with an ICER of $8,373/QALY over the lifetime horizon. Rituximab was pricier upfront, at $28,007, with an additional 3.34 QALYs compared with cyclosporine. Also, cheaper biosimilar rituximab became more favorable for ICER and dominance than cyclosporine. 

Investigators concluded that rituximab, even though it costs more, could still be an intelligent choice for treating membranous nephropathy compared to cyclosporine.

Source: academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfae084/7646078