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 language | English |
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Pages (from-to) | 214-223 |
Number of pages | 10 |
Journal | Annals of Internal Medicine |
Volume | 169 |
Issue number | 4 |
Early online date | 10 Jul 2018 |
DOIs | |
Publication status | Published - 21 Aug 2018 |
Externally published | Yes |
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