Cost-Effectiveness of Everolimus Combination Therapy in Patients After Liver Transplantation Focusing on Cancer Risk: A Markov Model Using Real-World Data
Author(s)
Jang SC1, Kim HL2, Kim GA3, Lim YS4, Lee EK5
1School of Pharmacy, Sungkyunkwan University, Suwon-si, 41, South Korea, 2College of Pharmacy, Sahmyook University, Seoul, Korea, Republic of (South), 3Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea, Republic of (South), 4Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), 5School of Pharmacy, Sungkyunkwan University, Suwon, Korea, Republic of (South)
Presentation Documents
OBJECTIVES: The potential of everolimus (EVR) in reducing hepatocellular carcinoma (HCC) among the patients on immunosuppressants after liver transplantation (LT) has been reported. Thus, we aimed to investigate whether combining EVR with standard calcineurin inhibitor (CNI) therapy affects the risk of HCC and extrahepatic cancers and assess its cost-effectiveness.
METHODS: A time-duration matched retrospective cohort of 1,864 patients who started immunosuppressants after LT from June 2015 to February 2020 was collected from the Korean Health Insurance Review and Assessment Service. The clinical outcomes of the patients who received EVR with CNI therapy (EVR group) were compared with those who received CNI therapy alone (non-EVR group). Using these as input parameters, a Markov model was designed with the liver and infection pathway to consider coexisting diseases simultaneously and simulated a cohort of 10,000 55-year-old LT patients to compare the expected costs and quality-adjusted life-years (QALYs) of combining EVR over a 30-year horizon. The incremental cost-effective ratio (ICER) using QALY and HCC-case-avoid was calculated.
RESULTS: During the study period, 55 and 41 patients developed HCC and extrahepatic cancers. The EVR group showed a lower risk of HCC (adjusted hazard ratio [aHR], 0.53; 95% confidence interval [CI] 0.30-0.94) and extrahepatic cancers (aHR, 0.30; 95% CI 0.14-0.63) compared with the non-EVR group. The EVR group was more vulnerable to infection from one year after LT (aHR, 1.47; 95% CI 1.05-2.05). From the healthcare system perspective, the EVR group had an ICER of USD 13,964/QALY and 54,246/HCC-case-avoid. From the societal perspective considering productivity loss by premature death, the EVR group had an ICER of USD 9,694/QALY and 37,659/HCC-case-avoid.
CONCLUSIONS: Combining EVR with CNI therapy reduced the risk of HCC and extrahepatic cancers in patients who underwent LT. Adding EVR to CNI therapy was more cost-effective than CNI therapy alone at a socially agreed ICER threshold of USD 20,000/QALY.
Conference/Value in Health Info
Value in Health, Volume 25, Issue 12S (December 2022)
Code
EE204
Topic
Economic Evaluation, Epidemiology & Public Health, Study Approaches
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Safety & Pharmacoepidemiology
Disease
SDC: Gastrointestinal Disorders, SDC: Infectious Disease (non-vaccine), SDC: Oncology