Abstract
As of 2014, there were approximately 8,300 patients with a functioning liver transplant in the UK Transplant Registry, with 880 liver transplants performed in 2013–14 alone. As the number of surviving liver transplant recipients continues to increase, healthcare expenditure in these patients should be periodically reviewed to maximize value for money. With tacrolimus representing the current cornerstone of post-transplant immunosuppressive therapy, the present study objective was to evaluate the cost-effectiveness of prolonged-release (PR) tacrolimus versus immediate-release (IR) tacrolimus. A model was developed in Microsoft Excel to evaluate the cost and effectiveness of immunosuppressive regimens in liver transplant recipients. The model captured costs associated with immunosuppressive medications, retransplantation and acute rejection. Three-year patient and graft survival data were taken from a recent retrospective European registry analysis and initial dose data were taken from the prescribing information. Costs were taken from the British National Formulary and the National Health Service National Tariff and expressed in 2014 pounds sterling. Over a 3 year time horizon, the number needed to treat (NNT) with PR tacrolimus relative to IR tacrolimus was ~13 to avoid one graft loss and 17 to avoid one death. The model was sensitive to dosing assumptions, with incremental cost estimates varying between a saving of GBP 2,236 per treated patient, assuming the same dosing of PR and IR (per kilogram bodyweight) and an increase of GBP 781 using RCT dose data. Data from a recent analysis of routine clinical practice data in liver transplant recipients on PR and IR tacrolimus showed significant differences in long-term graft survival in favor of PR tacrolimus. Modeling these data in a UK population showed that, over a three-year time horizon one graft would be saved for approximately every 13 patients treated with PR tacrolimus with minimal impact on costs.
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