Author information
1
Massachusetts General Hospital Institute for Technology Assessment, Boston, MA; Harvard Medical School, Boston, MA; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA.
2
Massachusetts General Hospital Institute for Technology Assessment, Boston, MA; Harvard Medical School, Boston, MA.
3
Department of Medicine, Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX; Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
4
Department of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA.
5
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh School of Medicine, Pittsburgh, PA.
6
University of California San Francisco Medical Center, San Francisco, CA.
7
Harvard Medical School, Boston, MA; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA.
8
Massachusetts General Hospital Institute for Technology Assessment, Boston, MA; Harvard Medical School, Boston, MA; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA. Electronic address: JagChhatwal@mgh.harvard.edu.
Abstract
BACKGROUND & AIMS:
Guidelines do not recommend transplanting hepatitis C virus (HCV)-infected livers into HCV-uninfected recipients. Direct-acting antivirals (DAAs) can be used to treat donor-derived HCV infection. However the added cost of DAA therapy is a barrier. We evaluated the cost effectiveness of transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy.
METHODS:
A previously validated Markov-based mathematical model was adapted to simulate a virtual trial of HCV-negative patients on the liver transplant waitlist. The model compared long-term clinical and economic outcomes in patients willing to accept only HCV-negative livers vs those willing to accept any (HCV-negative or HCV-positive) liver. Recipients of HCV-positive livers received 12 weeks of preemptive DAA therapy. The model incorporated data from the United Network for Organ Sharing and published sources.
RESULTS:
For patients with a model for end-stage liver disease (MELD) score ≥ 22, accepting any liver vs waiting for only HCV-negative livers was cost effective, with incremental cost-effectiveness ratios ranging from $56,100 to $91,700/quality-adjusted life year. For patients with a MELD score of 28 (the median MELD score of patients undergoing transplantation in the United States), accepting any liver was cost effective at an incremental cost-effectiveness ratio of $62,600/quality-adjusted life year. In patients with low MELD scores that may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score.
CONCLUSIONS:
Using a Markov-based mathematical model, we found transplanting HCV-positive livers in HCV-negative patients with preemptive DAA therapy to be a cost-effective strategy that could improve health outcomes.