Vanderbilt Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
Am J Surg. 2022 May;223(5):975-982. doi: 10.1016/j.amjsurg.2021.09.005. Epub 2021 Sep 14.
Emerging data supports expanding the solid organ donor pool with transplantation from hepatitis C virus (HCV)-positive donors into HCV-negative recipients. However, concerns exist regarding the ability to access direct-acting antivirals (DAAs) post-transplant in a real-world setting.
This single-center, retrospective study evaluated DAA access rates, time to first dose, and patient cost in donor-derived HCV solid-organ transplant recipients utilizing an integrated specialty pharmacy process.
Among 91 patients, all accessed DAAs through prescription insurance (97%) or patient assistance programs (3%). Of those who received DAAs through insurance, only 65% received approval on initial insurance submission. Median time from transplant to first dose was 45d [IQR 34-66]. The on-site specialty pharmacy was used by 69% of patients. Copay assistance programs reduced the median monthly patient cost from $1914 [range $7-7536] to $0 [range $0-5].
Our findings indicate that access to DAAs in donor-derived HCV post-transplant is achievable and affordable; however, significant added administrative efforts may be required for insurance approval as well as obtaining copay assistance, which is a limited resource.
新出现的数据支持将丙型肝炎病毒（HCV）阳性供体移植到 HCV 阴性受者中，以扩大实体器官捐献者群体。然而，在实际环境中，人们对移植后获得直接作用抗病毒药物（DAA）的能力存在担忧。
本单中心回顾性研究通过综合专科药房流程，评估了供体来源 HCV 实体器官移植受者获得 DAA 的比率、首次用药时间和患者费用。
在 91 例患者中，所有患者均通过处方保险（97%）或患者援助计划（3%）获得 DAA。在通过保险获得 DAA 的患者中，只有 65%在初次保险提交时获得批准。从移植到首次用药的中位时间为 45d [IQR 34-66]。现场专科药房被 69%的患者使用。共付援助计划将中位每月患者费用从 1914 美元（范围 7-7536 美元）降低至 0 美元（范围 0-5 美元）。
我们的研究结果表明，在 HCV 供体移植后获得 DAA 是可行且负担得起的；然而，获得保险批准以及获得共付援助可能需要大量额外的行政工作，而共付援助是一种有限的资源。
