Clinical Impact and Cost-effectiveness of Everolimus Combination Therapy in Liver Transplant Recipients: Focus on the...

Post-liver transplant complications-cancer, infections, and renal dysfunction-impose substantial clinical and economic impact on recipients. This study evaluated clinical impacts and cost-effectiveness of adding everolimus (EVR) to a calcineurin inhibitor (CNI)-based regimen in liver transplant recipients, aiming to identify how co-occurring major complications affect cost-effectiveness.

We conducted a cohort analysis and a cost-utility analysis, dividing recipients into CNI with and without EVR groups. We calculated adjusted hazard ratios (HRs) for the risk of cancer and posttransplant infection with EVR combination therapy using a Cox regression model. A Markov model that captured the co-occurrence of liver disease, infection, and renal dysfunction was constructed to estimate costs and quality-adjusted life years (QALYs) and compare the incremental cost-effectiveness ratio (ICER) of adding EVR to CNI. A hypothetical cohort of 10 000 liver transplant recipients aged 55 y was simulated during 30 y.

The addition of EVR significantly reduced the risk of cancer (HR 0.435; 95% confidence interval 0.279-0.678) while increasing the infection risk in subsequent years (HR 1.468; 95% confidence interval 1.053-2.045). Cost-utility analysis demonstrated the CNI with EVR strategy was cost-effective, with an ICER of US$5298/QALY, well below the $25 000/QALY threshold. In analyses quantifying how co-occurring events shift value, the ICER was $9307/QALY when limited to liver disease, decreased to $4363/QALY with renal dysfunction included, and increased to $10 464/QALY when infection was added.

Overall, CNI with EVR regimen in liver transplant remained cost-effective across co-occurring outcomes and perspectives, supporting risk-benefit balancing across cancer, posttransplant infection, and renal function.