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Cost-effectiveness of Using Kidneys From HCV-Viremic Donors for Transplantation Into HCV-Uninfected Recipients
Mark H Eckman1, E Steve Woodle2, Charuhas V Thakar3
1Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati Medical Center, Cincinnati, OH.
Insights
Transplanting kidneys from hepatitis C virus (HCV)-viremic donors into HCV-uninfected recipients is cost-effective, increasing life expectancy and reducing costs. This approach offers a viable solution given the low kidney transplant rates and high discard rates of available organs.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Disease
Background:
- Kidney transplantation is limited, with less than 4% of patients with kidney failure receiving transplants.
- Despite declining rates, approximately 39% of hepatitis C virus (HCV)-viremic kidneys were discarded between 2018-2019.
- Highly effective direct-acting antiviral agents are now available for treating HCV infection.
Purpose of the Study:
- To evaluate the cost-effectiveness of transplanting HCV-viremic donor kidneys into HCV-uninfected recipients.
- To compare this strategy against traditional transplantation with HCV-unexposed kidneys.
Main Methods:
- A Markov state transition decision model was employed.
- Data were sourced from the Scientific Registry of Transplant Recipients, US Renal Data System, and literature searches.
- The analysis used a healthcare system perspective with a lifelong time horizon.
Main Results:
- Transplanting HCV-viremic kidneys was more effective and less costly than using HCV-unexposed kidneys.
- This was attributed to longer waiting times for unexposed kidneys and the high efficacy of HCV treatments.
- The strategy remained cost-effective even with extended waiting times for HCV-viremic kidneys.
Conclusions:
- Transplanting kidneys from HCV-viremic donors into HCV-uninfected recipients improves quality-adjusted life expectancy.
- This strategy also leads to reduced healthcare costs compared to transplanting from HCV-unexposed donors.
- The availability of effective HCV treatments makes this a favorable approach for kidney transplant candidates.
Rationale & Objective:
Less than 4% of patients with kidney failure receive kidney transplants. Although discard rates of hepatitis C virus (HCV)-viremic kidneys are declining, ~39% of HCV-viremic kidneys donated between 2018 and 2019 were discarded. Highly effective antiviral agents are now available to treat chronic HCV infection. Thus, our objective was to examine the cost-effectiveness of transplanting kidneys from HCV-viremic donors into HCV-uninfected recipients.
Study Design:
Markov state transition decision model. Data sources include Medline search results, bibliographies from relevant English language articles, Scientific Registry of Transplant Recipients, and the US Renal Data System.
Setting & Population:
US patients receiving maintenance hemodialysis who are on kidney transplant waiting lists.
Intervention(S):
Transplantation with an HCV-unexposed kidney versus transplantation with an HCV-viremic kidney and HCV treatment.
Outcomes:
Effectiveness measured in quality-adjusted life-years and costs measured in 2018 US dollars.
Model, Perspective, And Timeframe:
We used a health care system perspective with a lifelong time horizon.
Results:
In the base-case analysis, transplantation with an HCV-viremic kidney was more effective and less costly than transplantation with an HCV-unexposed kidney because of the longer waiting times for HCV-unexposed kidneys, the substantial excess mortality risk while receiving dialysis, and the high efficacy of direct-acting antiviral agents for HCV infection. Transplantation with an HCV-viremic kidney was also preferred in sensitivity analyses of multiple model parameters. The strategy remained cost-effective unless waiting list time for an HCV-viremic kidney exceeded 3.1 years compared with the base-case value of 1.56 year.
Limitations:
Estimates of waiting times for patients willing to accept an HCV-viremic kidney were based on data for patients who received HCV-viremic kidney transplants.
Conclusions:
Transplanting kidneys from HCV-viremic donors into HCV-uninfected recipients increased quality-adjusted life expectancy and reduced costs compared with a strategy of transplanting kidneys from HCV-unexposed donors.
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