Transplanting Hepatitis C virus–infected versus uninfected kidneys into Hepatitis C virus–infected recipients: a cost-effectiveness analysis

Mark H Eckman, E Steve Woodle, Charuhas V Thakar, Flavio Paterno, Kenneth E Sherman

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

BACKGROUND: Direct-acting antiviral agents are now available to treat chronic hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD).

OBJECTIVE: To examine whether it is more cost-effective to transplant HCV-infected or HCV-uninfected kidneys into HCV-infected patients.

DESIGN: Markov state-transition decision model.

DATA SOURCES: MEDLINE searches and bibliographies from relevant English-language articles.

TARGET POPULATION: HCV-infected patients with ESRD receiving hemodialysis in the United States.

TIME HORIZON: Lifetime.

PERSPECTIVE: Health care system.

INTERVENTION: Transplant of an HCV-infected kidney followed by HCV treatment versus transplant of an HCV-uninfected kidney preceded by HCV treatment.

OUTCOME MEASURES: Effectiveness, measured in quality-adjusted life-years (QALYs), and costs, measured in 2017 U.S. dollars.

RESULTS OF BASE-CASE ANALYSIS: Transplant of an HCV-infected kidney followed by HCV treatment was more effective and less costly than transplant of an HCV-uninfected kidney preceded by HCV treatment, largely because of longer wait times for uninfected kidneys. A typical 57.8-year-old patient receiving hemodialysis would gain an average of 0.50 QALY at a lifetime cost savings of $41 591.

RESULTS OF SENSITIVITY ANALYSIS: Transplant of an HCV-infected kidney followed by HCV treatment continued to be preferred in sensitivity analyses of many model parameters. Transplant of an HCV-uninfected kidney preceded by HCV treatment was not preferred unless the additional wait time for an uninfected kidney was less than 161 days.

LIMITATION: The study did not consider the benefit of decreased HCV transmission from treating HCV-infected patients.

CONCLUSION: Transplanting HCV-infected kidneys into HCV-infected patients increased quality-adjusted life expectancy and reduced costs compared with transplanting HCV-uninfected kidneys into HCV-infected patients.

PRIMARY FUNDING SOURCE: Merck Sharp & Dohme and the National Center for Advancing Translational Sciences.

Original languageEnglish
Pages (from-to)214-223
Number of pages10
JournalAnnals of Internal Medicine
Volume169
Issue number4
Early online date10 Jul 2018
DOIs
Publication statusPublished - 21 Aug 2018
Externally publishedYes

Keywords

  • Antiviral Agents/therapeutic use
  • Comparative Effectiveness Research
  • Cost-Benefit Analysis
  • Hepatitis C, Chronic/complications
  • Humans
  • Kidney Failure, Chronic/complications
  • Kidney Transplantation/economics
  • Markov Chains
  • Middle Aged
  • Quality-Adjusted Life Years
  • Renal Dialysis
  • Sensitivity and Specificity
  • Tissue Donors

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