To analyze the characteristics of immunosuppressant usage and medication expenses among liver transplant recipients in China.

A retrospective analysis was conducted using prescription data from liver transplant outpatient departments in 95 hospitals across 9 cities in China from January 2017 to December 2021. The included institutions consisted of 87 tertiary hospitals, 7 secondary hospitals, and 1 primary hospital. Outpatient prescriptions were included if they involved patients who had undergone liver transplantation and were prescribed at least one type of immunosuppressant. A two-stage sampling method was used for sample selection. Prescription data were counted based on the number of outpatient visits. If a patient had multiple prescriptions during a single visit, it was counted as one visit. If the same patient had multiple visits, the total number of visits were counted. Information including age, sex, prescription costs and visit counts were extracted from the immunosuppressant prescriptions for liver transplant recipients to analyze the characteristics and trends of immunosuppressant usage.

A total of 106 428 outpatient visits for liver transplant prescriptions were retrieved, with Shanghai having the highest number of visits, accounting for 37.90% (40 339) of the total visits. The age distribution of liver transplant recipients remained consistent from 2017 to 2021, with the majority being between 46 and 60 years old. The sex composition also remained relatively consistent across the years. A total of 112 137 liver transplant outpatient reimbursement data were obtained. The proportion of different reimbursement types remained stable from 2017 to 2021, with the majority being partial health insurance and self-payment, accounting for 58.21% (65 274/112 137) and 24.60% (27 587/112 137), respectively. The total number of liver transplant outpatient visits showed an upward trend from 2017 to 2021. The average costs of immunosuppressant per visit increased annually from 2018 to 2020, and the proportion of immunosuppressant costs in the total prescription costs showed an increasing trend. Among the liver transplant prescriptions with specific immunosuppressive regimens (53 084 visits), regimens based on tacrolimus had a relatively high costs proportion. The combination of tacrolimus and mycophenolic acid had the highest cost among all immunosuppressive regimens. Among the regimens based on cyclosporine, the combination of cyclosporine and mycophenolic acid had the highest costs. Among the top 5 immunosuppressive regimens in terms of usage, 4 were based on tacrolimus. Monotherapy with tacrolimus was the most commonly used, followed by the combination of tacrolimus and mycophenolic acid. Among the triple regimens, the combination of tacrolimus, mycophenolic acid, and glucocorticoids had the highest usage, and regimens based on cyclosporine had a relatively lower number of users.

From 2017 to 2021, with the increase in the number of liver transplant surgeries in China, the total costs of immunosuppressants showed an upward trend. Tacrolimus monotherapy and the combination of tacrolimus and mycophenolic acid have become the main immunosuppressive maintenance regimens after liver transplantation.