Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
Transplantation. 2023 Apr 1;107(4):961-969. doi: 10.1097/TP.0000000000004378. Epub 2022 Oct 27.
The DONATE HCV trial demonstrated the safety and efficacy of transplanting hearts from hepatitis C viremic (HCV+) donors. In this report, we examine the cost-effectiveness and impact of universal HCV+ heart donor eligibility in the United States on transplant waitlist time and life expectancy.
We developed a microsimulation model to compare 2 waitlist strategies for heart transplant candidates in 2018: (1) status quo (SQ) and (2) SQ plus HCV+ donors (SQ + HCV). From the DONATE HCV trial and published national datasets, we modeled mean age (53 years), male sex (75%), probabilities of waitlist mortality (0.01-0.10/month) and transplant (0.03-0.21/month) stratified by medical urgency, and posttransplant mortality (0.003-0.052/month). We assumed a 23% increase in transplant volume with SQ + HCV compared with SQ. Costs (2018 United States dollar) included waitlist care ($2200-190 000/month), transplant ($213 400), 4-wk HCV treatment ($26 000), and posttransplant care ($2500-11 300/month). We projected waitlist time, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs [$/QALY, discounted 3%/year]; threshold ≤$100 000/QALY).
Compared with SQ, SQ + HCV decreased waitlist time from 8.7 to 6.7 months, increased undiscounted life expectancy from 8.9 to 9.2 QALYs, and increased discounted lifetime costs from $671 400/person to $690 000/person. Four-week HCV treatment comprised 0.5% of lifetime costs. The ICER of SQ + HCV compared with SQ was $74 100/QALY and remained ≤$100 000/QALY with up to 30% increases in transplant and posttransplant costs.
Transplanting hearts from HCV-infected donors could decrease waitlist times, increase life expectancy, and be cost-effective. These findings were robust within the context of current high HCV treatment costs.
DONATE HCV 试验证明了从丙型肝炎病毒（HCV+）供体移植心脏的安全性和有效性。在本报告中，我们研究了在美国普遍适用 HCV+心脏供体资格对移植等待时间和预期寿命的成本效益和影响。
我们开发了一个微观模拟模型，以比较 2018 年心脏移植候选者的两种等待名单策略：（1）现状（SQ）和（2）SQ 加 HCV+供体（SQ + HCV）。根据 DONATE HCV 试验和已发表的全国数据集，我们对平均年龄（53 岁）、男性比例（75%）、按医疗紧急程度分层的等待名单死亡率（0.01-0.10/月）和移植概率（0.03-0.21/月）以及移植后死亡率（0.003-0.052/月）进行了建模。我们假设与 SQ 相比，SQ + HCV 会使移植量增加 23%。成本（2018 年美元）包括等待名单护理（2200-190000 美元/月）、移植（213400 美元）、4 周 HCV 治疗（26000 美元）和移植后护理（2500-11300 美元/月）。我们预测了等待名单时间、质量调整生命年（QALYs）、终身成本和增量成本效益比（ICERs [$/QALY，贴现率 3%/年]；阈值≤$100000/QALY）。
与 SQ 相比，SQ + HCV 将等待时间从 8.7 个月缩短至 6.7 个月，未贴现预期寿命从 8.9 个 QALYs 增加至 9.2 个 QALYs，贴现终身成本从 671400 美元/人增加至 690000 美元/人。4 周 HCV 治疗占终身成本的 0.5%。与 SQ 相比，SQ + HCV 的 ICER 为 74100 美元/QALY，并且在移植和移植后成本增加高达 30%的情况下，仍保持在≤$100000/QALY 以内。
从 HCV 感染供体移植心脏可以减少等待时间、延长预期寿命，并具有成本效益。这些发现基于当前 HCV 治疗成本较高的情况下是稳健的。
