How Does Treating Chronic Hepatitis C Affect Individuals in Need of Organ Transplants in the United Kingdom?

Area of Science:

• Hepatology and Transplant Medicine
• Public Health and Health Economics
• Organ Donation and Transplantation Policy

Background:

• Chronic hepatitis C (CHC) infection is a significant cause of liver disease, often leading to liver transplantation.
• Current organ donation models do not fully account for the potential benefits of CHC cures on organ availability.
• Understanding the broader impact of CHC treatment is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

• To estimate the impact of curing CHC infection on organ donation rates and transplant outcomes in the United Kingdom.
• To quantify the economic value (net present value) of CHC cures considering both reduced transplant demand and increased organ supply.
• To compare the effects of CHC cures under different organ donation policies (opt-in vs. opt-out).

Main Methods:

• Adaptation of a double-queuing model for organ allocation to simulate CHC cure scenarios.
• Assumption that cured individuals donate organs at general population rates and no longer require liver transplants due to CHC.
• Calculation of waitlist length changes and societal net present value based on quality-adjusted life-years (QALYs) gained.

Main Results:

• Curing CHC significantly benefits liver transplant waitlists, reducing length by 24% and generating £34.3 million annually under opt-in policies.
• Increased organ availability from cured individuals adds £19.2 million annually, with kidneys contributing £18.7 million.
• Implementing an opt-out policy alongside CHC cures could decrease liver waitlist length by 75%, addressing one-third of the excess waitlist.

Conclusions:

• Treating CHC infection yields substantial positive spillovers for uninfected individuals by reducing liver transplant demand and enabling organ donation.
• These indirect benefits, or spillovers, are often excluded from traditional economic evaluations of CHC treatments.
• Integrating the full impact of CHC cures into value assessments is essential for comprehensive healthcare planning and policy development.