{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:51:41Z","timestamp":1791348701864,"version":"4.3.1"},"reference-count":47,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      This study aimed to evaluate the long\u2010term cost\u2010effectiveness of belatacept\n                      <jats:italic>vs<\/jats:italic>\n                      . tacrolimus as maintenance immunosuppression in adult kidney transplant recipients, focusing on the trade\u2010off between reduced new\u2010onset diabetes after transplantation (NODAT), immunological risk and potential renal benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort Markov model with a 20\u2010year horizon was developed from the Italian National Health Service perspective as the primary cost\u2010effectiveness framework and complemented by individual\u2010level Monte Carlo microsimulation to characterize variability in simulated clinical trajectories and outcome distributions. Five health states were modelled: functioning graft, functioning graft with NODAT, graft loss, retransplantation and death. Clinical inputs were drawn from comparative studies and a randomized trial. Outcomes were costs, life\u2010years (LYs), quality\u2010adjusted life\u2010years (QALYs), incremental cost\u2010effectiveness ratios (ICERs) and incremental net monetary benefit (INMB). Deterministic and probabilistic sensitivity analyses and multiple scenarios assessed robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Belatacept incurred higher lifetime costs than tacrolimus (\u20ac340\u2009569\n                      <jats:italic>vs<\/jats:italic>\n                      . \u20ac188\u2009816; incremental \u20ac151\u2009753) for gains (11.19\n                      <jats:italic>vs<\/jats:italic>\n                      .11.10 QALYs), giving an ICER of \u20ac1\u2009540\u2009779\/QALY and a negative INMB at \u20ac30\u2009000\/QALY. The most favourable scenario (renal benefit) reduced the ICER to \u20ac604\u2009095\/QALY; alternative rejection assumptions gave comparable results. Probabilistic analysis confirmed non\u2013cost\u2010effectiveness (aggregate ICER \u20ac1\u2009596\u2009119\/QALY; ~0% probability of cost\u2010effectiveness at \u20ac30\u2009000\u2013\u20ac50\u2009000\/QALY). Microsimulation showed lower NODAT incidence and longer functioning graft persistence with belatacept, with an incremental QALY advantage emerging mainly in the second decade.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Belatacept offers metabolic advantages and modest quality\u2010adjusted survival gains but is not cost\u2010effective\n                      <jats:italic>vs<\/jats:italic>\n                      . tacrolimus owing to substantially higher costs. Whether longer lived or higher metabolic\u2010risk recipients derive acceptable value is a hypothesis requiring dedicated age\u2010 and risk\u2010stratified evaluation.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bcp.70859","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:35:43Z","timestamp":1791347743000},"source":"Crossref","is-referenced-by-count":0,"title":["Long\u2010term cost\u2010effectiveness of belatacept\n                    <i>vs<\/i>\n                    . tacrolimus in kidney transplantation: Trade\u2010off between metabolic benefit and immunological risk"],"prefix":"10.1002","author":[{"given":"Salvatore","family":"Di Maria","sequence":"first","affiliation":[{"name":"School of Specialization in Hospital Pharmacy University of Catania  Catania 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