Author information
1
University of Cincinnati, Cincinnati, Ohio (M.H.E., E.S.W., C.V.T., F.P., K.E.S.).
Abstract
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.