Transplanting Hepatitis C Virus-Infected Versus Uninfected Kidneys Into Hepatitis C Virus-Infected Recipients: A Cost-Effectiveness Analysis.

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.