title: Cost-effectiveness of everolimus plus reduced tacrolimus in de novo liver-recipients in the Italian setting.
abstract: BACKGROUND
  Long-term exposure to calcineurin inhibitor-based immunosuppressant (IS) therapy in liver transplant (LT) recipients is associated with renal complications. In the randomized trial H2304, everolimus + reduced-dose tacrolimus (EVR + rTAC) demonstrated equivalent efficacy and superior renal function compared to standard-dose tacrolimus.
  
  
  METHODS
  To evaluate the cost-effectiveness of EVR + rTAC vs TAC, in de novo LT patients, a Markov model simulating both liver and kidney function was developed and estimated the long-term outcomes of IS following LT. The analysis used the Italian healthcare payer perspective.
  
  
  RESULTS
  Patients treated with EVR + rTAC gained on average 1.92 years and 1.62 quality-adjusted life years (QALYs). The incremental cost-effectiveness ratios (ICER) were €35,851 and €42,567 for LY gained and QALY gained, respectively. For the hepatitis-c sub-population, the ICERs decreased to €22,519 and €30,658, respectively.
  
  
  CONCLUSIONS
  EVR + rTAC improves survival and quality-of-life and is a cost-effective alternative to calcineurin-inhibitor monotherapy for patients requiring LT.
authors.affiliation: a Mapi Group , Nanterre , France ;
authors.forename: Florence
authors.initials: F
authors.lastname: Bianic
authors.affiliation: b Mapi Group , Uxbridge , UK ;
authors.forename: Rosanne
authors.initials: R
authors.lastname: Campbell
authors.affiliation: b Mapi Group , Uxbridge , UK ;
authors.forename: Vidya
authors.initials: V
authors.lastname: Damera
authors.affiliation: c University of Pisa Medical School Hospital , Pisa , Italy ;
authors.forename: Paolo
authors.initials: P
authors.lastname: De Simone
authors.affiliation: d Novartis Farma , Origgio , Italy ;
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roccia
authors.affiliation: e Novartis AG Ringgold , Basel , Basel - Stadt , Switzerland ;
authors.forename: Jill
authors.initials: J
authors.lastname: Gregson
authors.affiliation: f Wellmera AG Ringgold , Basel , Basel - Stadt , Switzerland.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Ricci
mesh_terms: D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D000068338:Everolimus / Q000191:economics* / Q000627:therapeutic use; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D007558:Italy; D016031:Liver Transplantation / Q000379:methods*; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D016559:Tacrolimus / Q000191:economics* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D000068338:Everolimus; D016559:Tacrolimus
keywords: Cost-effectiveness; Everolimus; Immunosuppressant therapies; Post-liver transplantation