Cost Effectiveness of Immunosuppression Withdrawal after Liver Transplantation

Abstract

Background Lifelong immunosuppression (IS) after liver transplantation (LT) is associated with severe side effects and increased recipients morbidity and mortality. Achievement of clinical operational tolerance has been reported up to 40% of LT recipients. We herein report the cost savings reached for the Italian National Health System with operational tolerant recipients. Methods Seventy five LT recipients were previously enrolled for IS withdrawal at our institution between April 1998 and December 2015. Study population included: 32 (42%) patients tolerant that completed the withdrawal of IS therapy; 41 (54%) patients transient tolerant who underwent IS resumption after clinical or biopsy-proven sign of rejection; two (3%) patients non-tolerant who developed early rejection at the first step of drug reduction. The endpoint of this study was to assess the long-term cost saving of IS withdrawal. Results The IS weaning results in a cost saving for the national health Italian system of 634.000 Euros (Figure 1) for a period of 95 months (IQR= 23-109). As a matter of fact, the participation to the IS withdrawal protocol did not result in patient or graft loss during the follow up period. Conclusion: The long term IS withdrawal represents a remarkable cost saving for the national health system without exposing recipients to graft loss.