Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California.
Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa.
Am J Transplant. 2021 Feb;21(2):657-668. doi: 10.1111/ajt.16245. Epub 2020 Sep 15.
Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes.
HCV 阳性供体心脏移植到 HCV 阴性受者体内后，受者的结局良好。我们评估了愿意和不愿意接受 HCV 阳性供体心脏的受者队列之间的成本效益。Markov 模型模拟了移植等待名单上 HCV 阴性患者的长期结局。我们比较了愿意接受任何心脏（包括 HCV 阳性）和仅愿意接受 HCV 阴性心脏的两个队列的成本（2018 年美元）和健康结果（质量调整生命年，QALY）。我们假设 4.9%的供体 HCV 阳性率。接受 HCV 阳性供体心脏的患者接受治疗，假设每个患者的治疗费用为 39600 美元，治愈率为 95%。与 10 万美元/QALY 的支付意愿阈值相比，比较了增量成本效益比（ICER）。敏感性分析包括按血型或地区分层，以及接受 HCV 阳性供体心脏的潜在负面影响。与仅接受 HCV 阴性心脏相比，接受任何心脏可增加 0.14 个生命年和 0.11 个 QALY，但每位患者的成本增加 9418 美元。接受任何心脏都是具有成本效益的（ICER 为 85602 美元/QALY）。除 AB 型外，所有移植区域和血型的结果均稳健。只要接受 HCV 阳性供体心脏的患者的移植后死亡率和成本与 HCV 阴性心脏相比不高出 7%，接受任何心脏仍然具有成本效益。愿意接受 HCV 阳性供体心脏移植到 HCV 阴性受者体内是具有成本效益的，并且可以改善临床结局。
