The Fiscal Pill Burden of Patients for the First 5 Years Following Live Donor Liver Transplantation

Background: Calcineurin inhibitors, particularly tacrolimus remain the mainstay of immunosuppressants following liver transplantation (LT). An often underestimated facet of immunosuppressive treatment is its financial impact, adding to the already substantial economic burden on liver transplant recipients. Aim: This observational and retrospective study aimed to assess the comprehensive cost of immunosuppressive treatment in adult patients above 18 years who had completed 5 years following transplantation. Methodology: During the study span, a group of 264 patients who had undergone LT from January 2016 to January 2018 were screened. Among them, 60 patients had completed 5 years after transplantation and had furnished the necessary information for the analysis. The cumulative expense associated with immunosuppressive treatment was determined by aggregating the costs of each prescribed immunosuppressive drug and the expenses incurred for drug level assessments along with ancillary medications within a monthly timeframe. Results: The total 5-year cost of posttransplant medications was summed to Rs. 765,926 (630,327–1,016,296). The median cost for the patient was maximal in the 1 st year, amounting to Rs. 183,791 (160,031–229,051) which declined to Rs. 114,495 (896,00–162,792) in the 5 th year due to the decrement of immunosuppressive agents to maintenance drugs. Notably, the expenses primarily stemmed from the cost of immunosuppressive medications, approximating 72% (Rs. 11,087) of the total fiscal pill burden in the 1 st year. Conclusion: The high cost of immunosuppressive therapy, particularly in the first year after liver transplantation, creates a major financial burden. To improve affordability and adherence, sustained public and policy support is essential.