Cost-effectiveness of everolimus in liver transplantation

Abstract

The purpose of this study was to analyze the cost-effectiveness of the association of EVR with reduced TAC doses in liver transplantation patients with renal dysfunction. Methods: A cost-effectiveness analysis was conduced from the National Public Health System perspective. A Markov model was constructed using TreeAge Software. In the model, the expected cost and effectiveness were compared between EVR and TAC reduced doses immunosuppression strategy versus TAC monotherapy. In both strategies, there were the possibilities of rejection, graft loss, renal failure and death. In 2014, 525 patients underwent for a liver transplantation in the National Public Health System and this was the population studied in the Monte Carlo microssimulation. Results: EVR associated a reduced TAC doses preserved 26.2% of renal function and decreased 7.2% of rejections. It can avoid 1.9% of renal transplantation and 7.8% of liver re-transplantation. The use of EVR associated with TAC reduced doses increase the annual treatment drug costs in $133.65 for the first year and $279.3 for the two first years per patient. Using EVR associated with TAC in patient with renal dysfunction after liver transplantation resulted in an annual cost 37% less than when use TAC. The Monte Carlo simulation for 525 potential patients resulted in a cost of $2,566.75 per year per patient free of complications treated with EVR associated with TAC reduced doses, 18% less than when patients are treated with TAC. Conclusion: Everolimus associated with reduced tacrolimus doses is cost-effective when analyzing the renal dysfunction avoided in the liver transplantation patient.