Cost-effectiveness of everolimus plus reduced tacrolimus in de novo liver-recipients in the Italian setting

Figures & data

Figure 1. Liver transplantation model structure.

Table 1. Unit cost per milligram.

	Price per mg (€)	Source
Everolimus	€12.65	Farmadati Italia 2013^26
Tacrolimus, CAP	€1.80	Farmadati Italia 2013^26

CAP, Capsule.

Table 2. Estimated annual health states costs (EUR; €).

Health state	Annual cost estimate		Source
	Original	Inflated 2013
Liver pathway
Recurrent Hepatitis C	€78.55	€87.33	Ruggeri et al.^24
HCV on anti-viral therapy	€14,129.18	€14,957.59	Camma et al.^28
Hepatitis C (F1–F2)	€110.19	€110.19	Assumption: half the cost of F3–F4
Hepatitis C (F3–F4)	€220.37	€233.29	Camma et al.^28
Compensated cirrhosis (F5–F6)	€479.07	€507.16	Camma et al.^28
Decompensated cirrhosis	€4994.28	€5287.10	Camma et al.^28
Recurrent HCC	€6438.79	€6816.30	Camma et al.^28
Acute rejection
Mild	€5674.93	€6803.67	Assumption: 60% of the cost of moderate AR
Moderate	€9458.22	€11,339.45	Assumption: half the cost of severe AR
Severe	€18,916.43	€22,678.91	Rufat et al.^29; costs converted from GBP (£12 595) to Euros using an exchange rate of 1.5019
Graft loss leading to re-transplant	€90.733.60	€96,053.43	Camma et al.^28
Post-acute rejection	€50.00	€50.00	ASSUMPTION
Post-liver transplant	€5923.46	€6270.76	Camma et al.^28
Kidney pathway
CKD: stage 1	—	—	Assumption
CKD: stage 2	€450.00	€498.66	Cicchetti et al.^30; Stage 2
CKD: stage 3a	€890.00	€986.25	Cicchetti et al.^30; Stage 3
CKD: stage 3b	€2141.00	€2372.53	Assumption: Average between stage 3a/4
CKD: stage 4	€3392.00	€3758.82	Cicchetti et al.^30; Stage 4
CKD: stage 5	€52,830.00	€58,543.20	Cicchetti et al.^30; Stage 5
Renal transplantation	€47,173.89	€49,939.76	DRG tariff 2011 Accordo Interrergionale per lacompensazione della mobilita sanitaria
Post-renal transplant	€6283.00	€6962.46	Villa et al.^31

CKD, Chronic kidney disease; HCC, Hepatocellular carcinoma.

Table 3. Health state utilities post-liver transplantation.

Health state	Utility	Method	Source
Post-liver transplant without major complication			Multiplicative factor for post-liver transplant condition
Early post-transplant (<6 months)	0.83	NA	Assumption: parameter of calibration
Intermediate post-transplant (7–36 months)	0.93	NA	Assumption: parameter of calibration
Late post-transplant (>36 months)	0.92	NA	Assumption: parameter of calibration
Liver pathway
HCV (F0–F2)	0.82	HUI3	Sullivan et al.^32
HCV (F3–F4)	0.80	NA	Assumption: lower than F0-F2
HCV anti-viral therapy	0.77	NA	Assumption; decrement of 0.05 due to adverse events
Compensated cirrhosis	0.78	HUI3	Sullivan et al.^32
Decompensated cirrhosis	0.65	NA	Sullivan et al.^32
HCC	0.25	HUI3	Sullivan et al.^32
Re-transplantation	0.50	HUI3	Sullivan et al.^32
Post-2nd liver transplant	0.70	HUI3	Sullivan et al.^32
Acute rejection
Mild	0.90	Other	Das^33; mean estimate
Moderate	0.85	Other	Das^33; lower limit
Severe	0.70	Other	Das^33; upper limit
Post-acute rejection	0.95	NA	Assumption
Kidney pathway
Reduced KF - Stage 1 & 2	1.00	NA	Assumption: no decrement in utility
Reduced KF - Stage 3a	0.87	TTO	Gorodetskaya et al.^34
Reduced KF - Stage 3b	0.86	TTO	Assumption: utility value between stage 3 and stage 4
Reduced KF - Stage 4	0.85	TTO	Gorodetskaya et al.^34
Reduced KF - Stage 5 (with dialysis)	0.77	TTO	Gorodetskaya et al.^34
Renal transplant	0.70	NA	McLaughlin et al.^35
Post-renal transplant	0.74	TTO	Laupacis et al.^36

TTO, time trade off; NA, Not applicable.

Table 4. Lifetime base case results.

	EVR + reduced TAC	TAC alone	Incremental
Outcomes
LY	18.16	16.24	1.92
QALY	14.74	13.12	1.62
Acute rejections	2.321	2912	−591
Costs
Total cost	€274,422	€205,432	€68,989
IS cost	€198,975	€129,031	€69,944
Renal complications	€41,938	€43,619	−€1681
Liver complications	€4460	€5513	−€1054
Monitoring and AE	€26,099	€24,244	€1855
ICER
Cost per LY gained			€35,851
Cost per QALY gained			€42,567

ICER, Incremental cost effectiveness ratio; LY, Life Years; QALY, Quality Adjusted Life Years; IS, Immunosuppressant.

Figure 2. Sub-group analyses results (lifetime horizon).

Figure 3. Tornado diagram: cost per QALY gained.

Figure 4. Cost-effectiveness acceptability curve.

Farmadati Italia 2013. Accessed: 15th June 2013. http://www.farmadati.it/

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