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Transplanting Hepatitis C Virus-Infected Versus Uninfected Kidneys Into Hepatitis C Virus-Infected Recipients: A

Mark H Eckman1, E Steve Woodle1, Charuhas V Thakar1

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

Annals of Internal Medicine
|July 11, 2018
PubMed

Insights

Transplanting hepatitis C virus (HCV)-infected kidneys into HCV-infected patients is more cost-effective and improves quality-adjusted life expectancy. This strategy offers significant cost savings and better outcomes for patients with end-stage renal disease (ESRD).

Area of Science:

  • Nephrology
  • Hepatology
  • Health Economics

Background:

  • Direct-acting antiviral agents are available for treating chronic hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD).
  • Kidney transplantation is a critical treatment option for patients with ESRD.

Purpose of the Study:

  • To determine the cost-effectiveness of transplanting HCV-infected versus HCV-uninfected kidneys into HCV-infected patients.
  • To compare patient outcomes and healthcare costs associated with different kidney transplant strategies for HCV-infected ESRD patients.

Main Methods:

  • A Markov state-transition decision model was utilized.
  • Data were sourced from MEDLINE searches and bibliographies of relevant English-language articles.
  • The analysis focused on HCV-infected patients with ESRD receiving hemodialysis in the United States over a lifetime horizon from a healthcare system perspective.

Main Results:

  • Transplanting an HCV-infected kidney followed by HCV treatment was more effective and less costly than transplanting an HCV-uninfected kidney preceded by HCV treatment.
  • Patients gained an average of 0.50 quality-adjusted life-years (QALYs) with a lifetime cost savings of $41,591.
  • This strategy remained preferred in sensitivity analyses, unless the wait time for an uninfected kidney was less than 161 days.

Conclusions:

  • Transplanting HCV-infected kidneys into HCV-infected patients increases quality-adjusted life expectancy and reduces costs.
  • This approach is a more effective and economical strategy for managing HCV in ESRD patients requiring kidney transplantation.
  • The study did not account for the benefit of reduced HCV transmission from treating infected patients.
Abstract

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