Cost of Terlipressin for Treatment of Hepatorenal Syndrome

Hepatorenal syndrome (HRS), a form of acute kidney failure, is a rare, acute, life-threatening complication of cirrhosis that carries a poor prognosis. The only drug approved by the US FDA to improve kidney function in adults with HRS and a rapid reduction in kidney function is terlipressin (TERLIVAZ®). The American College of Gastroenterology, AASLD, and international guidelines list terlipressin as a preferred treatment for HRS.

Xingyue Huang, PhD, and colleagues developed a decision-analytic model to estimate the cost per response of terlipressin plus albumin versus other unapproved treatments, including midodrine and octreotide plus albumin (M&O+albumin), and norepinephrine plus albumin (norepi+albumin) from the perspective of a US hospital. Results were reported during a poster session at the NKF Spring Clinical Meetings 2023 in a poster titled Treatment-Related Cost Analysis for Adults With Hepatorenal Syndrome With Rapid Reduction in Kidney Function.

The model was designed to estimate the treatment cost per response over 14 days. HRS reversal (complete response, defined as a decrease in serum creatinine from baseline to ≤1.5 mg/dL on treatment [up to 24 hours following last treatment dose]) or no HRS reversal (partial/no response). Data on efficacy, safety, and treatment duration were gathered from published head-to-head randomized international trials.

Total treatment costs included drug acquisition as well as treatment-related costs (intensive care unit [ICU] bed, dialysis [intermittent or continuous], pulse oximetry monitoring for terlipressin, and adverse events) were sourced from published literature. The cost per response (total treatment cost per HRS reversal) was estimated for each treatment. The number needed to treat, defined as the number of patients treated to achieve HRS reversal in one additional patient, was also estimated.

The cost per response of terlipressin plus albumin was lower than M&O+albumin ($85,315 vs $467,794) and norepi+albumin ($81,614 vs $139,324). The number needed to treat with terlipressin plus albumin was two patients versus 21 patients treated with M&O+albumin and four patients with norepi+albumin, respectively.

“This analysis shows that terlipressin is a cost-effective treatment due to its higher efficacy and administration in the non-ICU setting. Terlipressin is a value-based treatment option for appropriate adults with HRS with rapid reduction in kidney function.”

Source: Huang X, Bindra J, Chopra I, Niewoehner J, Wan GJ. Treatment-related cost analysis for adults with hepatorenal syndrome with rapid reduction in kidney function. Poster #10. Abstract of a poster presented at the National Kidney Foundation Spring Clinical Meetings 2023; April 11-15, 2023; Austin, Texas.