S1989 A Global Comparison of Liver Transplant Drug Pricing: US vs the G7 Countries and Australia
Bibliographic record
Abstract
Introduction: A major contributor to increased healthcare spending in the United States is drug pricing, as US drug prices are nearly 3x higher than those in other countries. Studies have predicted that adopting international reference pricing could lower US 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 US 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, and cyclosporine). Foreign currencies were converted to US dollars based on the conversion rate on January 1st, 2024. US prices were obtained from UptoDate’s listed representative average wholesale price. If a range of prices was provided, the lower price was selected. Results: US 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 US with the price range of $0.56-$2.68 among comparison countries. Similarly, mycophenolate sodium costs $8.14 in the US 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. US generic immunosuppressive drug prices were 6.32x the average generic prices of Canada, France, Japan, Italy, and Germany. Conclusion: This study demonstrates the significantly greater financial burden that liver transplant patients in the US face compared to liver transplant patients in 7 other major industrial countries. As the annual number of liver transplants in the US 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 (Table 1). Table 1. - Prices for each drug per country formulary are listed in USD. Generic prices are noted in parentheses Drug Unit (mg) United States Canada France UK Japan Italy Germany Australia Mycophenolate Mofetil 250 10.8 (0.32) 1.57 (0.28) 0.56 1.05 0.95 (0.65) 1.96 (0.98) 1.03 (0.92) 2.68 Mycophenolate Mofetil 500 21.59 (1.14) 3.14 (0.56) 1.11 0.15 3.93 (1.63) 1.83 (1.72) 2.68 Mycophenolate Sodium DR 180 8.14 (4.39) 1.51 (0.75) 0.86 1.03 1.73 (0.92) 1.02 (1.02) 0.97 Mycophenolate Sodium DR 360 16.29 (9.13) 3.02 (1.51) 1.72 2.05 3.47 (1.83) 1.77 (1.02) 1.95 Sirolimus 0.5 20.63 (8.47) 1.96 2.93 6.13 (5.85) 4.00 Sirolimus 1 41.25 (16.95) 6.89 3.91 3.67 9.29 12.10 (11.34) 8.00 Sirolimus 2 82.5 (31.5) 7.80 7.34 23.84 (21.53) 16.01 Tacrolimus 0.5 4.31 (1.26) 1.53 (0.77) 0.86 (0.66) 1.58 1.74 (1.05) 3.91 (3.41) 0.86 Tacrolimus 1 8.62 (1.64) 1.96 (0.98) 1.72 (1.30) 2.04 3.22 (1.91) 3.40 (1.91) 5.52 (4.81) 1.72 Advagraf 0.5 3.37 1.68 0.87 (0.83) 0.91 3.91 (3.41) 1.70 Advagraf 1 6.73 2.14 1.73 (1.64) 1.82 3.42 5.81 (4.80) 1.72 Advagraf 5 33.65 10.74 8.56 (8.13) 6.80 17.11 22.48 (19.54) 17.04 Envarsus 0.75 6.03 1.59 1.45 1.88 5.71 Envarsus 1 8.04 1.98 1.83 2.51 3.11 6.34 Envarsus 4 32.15 7.93 7.67 10.03 12.44 20.75 Everolimus 2.5 675.74 (578.55) 130.05 17.98 58.36 (6.51) 10.39 Everolimus 5 706.84 (605.16) 130.05 34.92 147.94 (88.93) 141.55 (13.81) 20.47 Everolimus 10 706.76 (605.16) 130.05 45.11 210.41 (126.45) 188.44 (24.76) 39.46 Cyclosporine 25 3.24 (2.10) 0.59 0.75 0.78 0.81 (0.46) 1.24 (0.55) 1.17 (1.17) 2.62 Cyclosporine 50 2.74 1.16 1.50 1.53 1.37 (0.86) 2.41 (1.08) 2.23 (2.03) 5.45 Cyclosporine 100 12.86 (8.40) 2.98 2.90 4.49 (2.02) 4.28 (4.37) 11.11
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".