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Published on: April 12, 2021
Cost minimization analysis of short-duration antiviral prophylaxis for hepatitis C positive donor kidney transplants
Background:
Trials describing 4-12 week courses of direct-acting antiviral drugs (DAAs) to treat hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R-transplants), may be limited in application by costs and delayed access to expensive DAAs. A short prophylactic strategy may be safer and cost-effective. Here, we report a cost minimization analysis using the health system perspective to determine the least expensive DAA regimen, using available published strategies.
Objectives:
To conduct cost-minimization analyses (CMAs) from the health system perspective of four DAA regimens to prevent and/or treat HCV transmission from D+/R-kidney transplants.
Methods:
CMAs comparing 4 strategies: 1) 7-day prophylaxis with generic sofosbuvir/velpatasvir (SOF/VEL), with 12-week branded glecaprevir/pibrentasvir (G/P) for those with transmission; 2) 8-day branded G/P prophylaxis, with 12-week branded SOF/VEL/voxilaprevir for those with transmission; 3) 4-week perioperative generic SOF/VEL prophylaxis, with 12-week branded G/P for those with transmission; and 4) 8-week branded G/P "transmit-and-treat." We included data from published literature to estimate the probability of viral transmission in patients who received DAA prophylaxis, and assumed a 100% transmission rate for those who received the "transmit-and-treat" approach.
Results:
In base-case analyses, strategies 1 (expected cost [EC]: $2326) and 2 (expected cost: $2646) were less expensive than strategies 3 (EC: $4859) and 4 (EC: $18,525). Threshold analyses for 7-day SOF/VEL versus 8-day G/P suggested that there were reasonable input levels at which the 8-day strategy may be least costly. The threshold values for the SOF/VEL prophylaxis strategies (7-day vs. 4- week) indicated that the 4-week strategy is unlikely to be less costly under any reasonable value of the input variables.
Conclusions:
Short duration DAA prophylaxis using 7 days of SOF/VEL or 8 days of G/P has the potential to yield significant cost savings for D+/R- kidney transplants.
Insights
Short-duration direct-acting antiviral (DAA) prophylaxis, specifically 7-day sofosbuvir/velpatasvir (SOF/VEL) or 8-day glecaprevir/pibrentasvir (G/P), offers significant cost savings for preventing hepatitis C virus (HCV) transmission in kidney transplants. These shorter regimens are more cost-effective than longer treatments or transmit-and-treat approaches.
Area of Science:
- Nephrology
- Hepatology
- Pharmacoeconomics
Background:
- Hepatitis C virus (HCV) transmission from infected donors to uninfected kidney transplant recipients (D+/R-) poses a clinical challenge.
- Current 4-12 week direct-acting antiviral drug (DAA) treatment protocols may be limited by high costs and delayed access.
- Short prophylactic DAA strategies offer a potentially safer and more cost-effective alternative.
Purpose of the Study:
- To conduct cost-minimization analyses (CMAs) from a health system perspective.
- To identify the least expensive DAA regimen for preventing/treating HCV transmission in D+/R- kidney transplants.
Main Methods:
- Compared four DAA strategies: 7-day generic SOF/VEL prophylaxis, 8-day branded G/P prophylaxis, 4-week generic SOF/VEL prophylaxis, and 8-week branded G/P transmit-and-treat.
- Utilized published literature to estimate DAA prophylaxis transmission probabilities.
- Assumed a 100% transmission rate for the transmit-and-treat approach.
Main Results:
- Strategies 1 (7-day generic SOF/VEL) and 2 (8-day branded G/P) were less expensive than strategies 3 (4-week SOF/VEL) and 4 (8-week G/P transmit-and-treat).
- Expected costs were $2326 for strategy 1 and $2646 for strategy 2.
- Threshold analyses indicated that 7-day SOF/VEL and 8-day G/P are the most cost-effective options, with the 4-week SOF/VEL strategy unlikely to be cost-saving.
Conclusions:
- Short-duration DAA prophylaxis, specifically 7 days of SOF/VEL or 8 days of G/P, can lead to substantial cost savings.
- These findings support the implementation of shorter DAA prophylactic regimens in D+/R- kidney transplant scenarios.
- Optimizing DAA strategies can improve the economic viability of kidney transplantation programs.
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