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Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients
Cathy Logan1, Ily Yumul2, Javier Cepeda1
1Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California.
Insights
Accepting hepatitis C virus (HCV)-viremic hearts for HCV-negative recipients is cost-effective, improving life-years and quality-adjusted life-years (QALYs) with successful HCV treatment.
Area of Science:
- Transplantation immunology
- Infectious disease management
- Health economics
Background:
- Hepatitis C virus (HCV) viremic organs pose a challenge in heart transplantation.
- Advancements in HCV treatment offer potential for utilizing these organs in HCV-negative recipients.
- Assessing the economic and clinical implications of this strategy is crucial.
Purpose of the Study:
- To evaluate the cost-effectiveness of accepting HCV-viremic donor hearts for HCV-negative heart transplant recipients.
- To compare long-term outcomes and costs between recipients accepting any donor heart versus only HCV-negative donor hearts.
- To determine the impact of HCV treatment on the overall value of HCV-viremic heart transplantation.
Main Methods:
- A Markov model simulated long-term outcomes for HCV-negative patients on the transplant waitlist.
- Costs (2018 USD) and quality-adjusted life-years (QALYs) were compared between two cohorts: accepting any heart vs. only HCV-negative hearts.
- Assumed a 4.9% HCV-viremic donor prevalence and a $39,600 treatment cost with 95% cure rate for HCV.
Main Results:
- Accepting any heart (including HCV-viremic) gained 0.14 life-years and 0.11 QALYs per patient.
- This strategy increased costs by $9,418 per patient, yielding an Incremental Cost-Effectiveness Ratio (ICER) of $85,602/QALY gained.
- Results remained robust across regions and blood types, with cost-effectiveness maintained unless post-transplant mortality/costs exceeded 7% higher than for HCV-negative hearts.
Conclusions:
- Accepting HCV-viremic donor hearts for HCV-negative recipients, coupled with effective HCV treatment, is a cost-effective strategy.
- This approach improves both survival and quality of life for heart transplant recipients.
- Expanding the donor pool through utilization of HCV-viremic hearts offers significant clinical and economic benefits.
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.
