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Abstract Details
Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients
Am J Transplant. 2020 Aug 10. doi: 10.1111/ajt.16245. Online ahead of print.
Cathy Logan1, Ily Yumul2, Javier Cepeda1, Victor Pretorius3, Eric Adler4, Saima Aslam1, Natasha K Martin15
Author information
1Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California.
2Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa.
3Division of Cardiothoracic Surgery, Department of Surgery, University of California San Diego, La Jolla, California.
4Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California.
5Population Health Sciences, University of Bristol, Bristol, UK.
Abstract
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.