New York-Presbyterian / Weill Cornell Medical Center New York, NY
Leah Yao, MD1, Xiaohan Ying, MD1, Arun B.. Jesudian, MD2, Stephen E. Congly, MD, MSc3 1New York-Presbyterian / Weill Cornell Medical Center, New York, NY; 2Weill Cornell Medicine, New York, NY; 3University of Calgary Cumming School of Medicine, Calgary, AB, Canada
Introduction: A major contributor to increased healthcare spending in the United States is drug pricing, as U.S. drug prices are nearly 3x higher than those in other countries. Studies have predicted that adopting international reference pricing could lower U.S. drug spending by 52%, or $83.5 billion, annually. The cost of immunosuppressive therapies can pose a significant financial burden to liver transplant recipients. Patients may be billed over $30,000 a year for transplant medications alone. This cross-sectional study aims to investigate the current price differences in immunosuppressive medications used for liver transplantation in the U.S. as compared to the G7 countries and Australia.
Methods: Publicly available drug formularies for Canada, UK, Japan, France, Germany, Italy, and Australia were used to collect 2024 prices for 8 commonly used liver transplant immunosuppressive medications (mycophenolate mofetil, mycophenolate sodium, sirolimus, tacrolimus, Advagraf®, Envarsus®, everolimus, & cyclosporine). Foreign currencies were converted to U.S. dollars based on the conversion rate on January 1st, 2024. U.S. prices were obtained from UptoDate®’s listed representative average wholesale price. If a range of prices was provided, the lower price was selected.
Results: U.S. originator prices for liver transplant medications were on average 4.84x the prices in G7 countries and Australia. At its lowest dose, mycophenolate mofetil costs $10.80 in the U.S. with the price range of $0.56-$2.68 among comparison countries. Similarly, mycophenolate sodium costs $8.14 in the U.S. compared to $0.97-$1.73 globally, sirolimus $20.63 vs. $1.96-$6.13, tacrolimus $4.31 vs. $0.86-$3.91, Advagraf® $3.37 vs. $0.87-$3.91, Envarsus® $6.03 vs. $1.45-$5.71, everolimus $675.74 vs. $10.39-$130.05, and cyclosporine $3.24 vs. $0.59-$2.62 globally. U.S. generic immunosuppressive drug prices were 6.32x the average generic prices of Canada, France, Japan, Italy, and Germany.
Discussion: This study demonstrates the significantly greater financial burden that liver transplant patients in the U.S. face compared to liver transplant patients in seven other major industrial countries. As the annual number of liver transplants in the U.S. continues to increase, the cost of these medications will substantially impact domestic healthcare spending. Future adoption of international reference pricing may help bridge this pricing disparity.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Leah Yao indicated no relevant financial relationships.
Xiaohan Ying indicated no relevant financial relationships.
Arun Jesudian: Bausch Health – Consultant. Madrigal Pharmaceuticals – Speakers Bureau. Novo Nordisk – Advisor or Review Panel Member, Consultant. Orphalan – Advisor or Review Panel Member, Consultant. Salix Pharmaceuticals – Consultant, Speakers Bureau.
Leah Yao, MD1, Xiaohan Ying, MD1, Arun B.. Jesudian, MD2, Stephen E. Congly, MD, MSc3. P4623 - A Global Comparison of Liver Transplant Drug Pricing: US vs the G7 Countries and Australia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
