Department of Medicine, Clinician Investigator Program, University of British Columbia, Vancouver, Canada.
Division of Nephrology, University of British Columbia, Vancouver, Canada.
Am J Transplant. 2018 Oct;18(10):2457-2464. doi: 10.1111/ajt.14929. Epub 2018 Jun 14.
Kidneys from deceased donors who are hepatitis C virus (HCV) nucleic acid test positive are infrequently used for transplantation in HCV-negative patients due to concerns about disease transmission. With the development of direct-acting antivirals (DAAs) for HCV, there is now potential to use these kidneys in HCV-negative candidates. However, the high cost of DAAs poses a challenge to adoption of this strategy. We created a Markov model to examine the cost-effectiveness of using deceased donors infected with HCV for kidney transplantation in uninfected waitlist candidates. In the primary analysis, this strategy was cost saving and improved health outcomes compared to remaining on the waitlist for an additional 2 or more years to receive a HCV-negative transplant. The strategy was also cost-effective with an incremental cost-effectiveness ratio of $56 018 per quality-adjusted life year (QALY) from the payer perspective, and $4647 per QALY from the societal perspective, compared to remaining on the waitlist for 1 additional year. The results were consistent in 1-way and probabilistic sensitivity analyses. We conclude that the use of kidneys from deceased donors with HCV infection is likely to lead to improved clinical outcomes at reduced cost for HCV-negative transplant candidates.
由于担心疾病传播，对于 HCV 阴性患者，很少使用 HCV 核酸检测阳性的已故供体的肾脏进行移植。随着直接作用抗病毒药物（DAAs）治疗 HCV 的发展，现在有可能将这些肾脏用于 HCV 阴性的候选者。然而，DAAs 的高昂成本给采用这种策略带来了挑战。我们创建了一个马尔可夫模型，以检验使用感染 HCV 的已故供体进行肾脏移植治疗未感染的候补者的成本效益。在主要分析中，与在候补名单上再等待额外的 2 年或更长时间以接受 HCV 阴性移植相比，这种策略具有成本效益，并且从支付者的角度来看，每增加一个质量调整生命年（QALY）的增量成本效益比为 56018 美元，从社会角度来看，每增加一个 QALY 的增量成本效益比为 4647 美元。与在候补名单上再等待 1 年相比，该策略在单向和概率敏感性分析中结果一致。我们得出结论，对于 HCV 阴性的移植候选者，使用感染 HCV 的已故供体的肾脏可能会降低成本，同时提高临床结果。
