Related Experiment Videos
Should hepatitis C-infected kidneys be transplanted in the United States?
1Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Insights
Transplanting hepatitis C virus (HCV) infected kidneys into HCV-infected recipients is more cost-effective and yields better patient outcomes than discarding them. This approach maximizes quality-adjusted life years (QALYs) compared to discarding infected organs.
Area of Science:
- Nephrology
- Transplantation Immunology
- Health Economics
Background:
- Hepatitis C virus (HCV) infection in renal transplantation is a significant concern.
- Debate exists on whether to discard HCV-infected kidneys or utilize them.
- Organ allocation policies for HCV-infected kidneys require economic evaluation.
Purpose of the Study:
- To conduct an economic appraisal of three theoretical organ allocation policies for HCV-infected kidneys.
- To compare the cost-utility of discarding infected kidneys versus transplanting them into infected recipients or regardless of HCV status.
Main Methods:
- A cost-utility analysis was performed using literature-based probabilities, costs, and patient outcomes.
- Three policies were evaluated: (a) discard all infected kidneys, (b) transplant into infected recipients only, (c) transplant regardless of HCV status.
- Quality-adjusted life years (QALYs) and costs were calculated for each policy.
Main Results:
- Discarding all HCV-infected kidneys (Option A) resulted in the fewest QALYs and highest costs, primarily due to patients remaining on dialysis.
- Transplanting infected kidneys into infected recipients (Option B) was projected to yield the most QALYs.
- Transplanting regardless of HCV status (Option C) incurred the lowest costs but had lower QALYs than Option B. The incremental cost utility of Option B over C was $13,954/QALY.
Conclusions:
- Transplanting HCV-infected kidneys into HCV-infected recipients is superior to a discard policy in terms of cost and patient outcomes.
- Ethical considerations regarding the transplantation of infected organs require further discussion among physicians, patients, and the public.
Abstract:
Over the past several years, the issue of hepatitis C virus (HCV) infection in renal transplantation has generated considerable interest. With the availability of a test for HCV, some but not all physicians have advocated that all HCV-infected kidneys be discarded. An economic appraisal was carried out to examine 3 theoretical policies of organ allocation for HCV-infected kidneys: (a) discard all infected kidneys, (b) transplant infected kidneys into infected donors only, or (c) transplant regardless of HCV status. Using probabilities, costs, and patient outcomes from the literature/best estimate, a cost-utility analysis was performed. Patients free of infection transplanted with an infected organ were assigned higher treatment costs and poorer outcomes compared with all other combinations. Assuming a potential to transplant 8100 kidneys per year, option A was predicted to produce the fewest total quality-adjusted life years (QALYs) and incur the highest costs (largely due to patients left on dialysis). Option B was projected to produce the most QALYs, whereas option C incurred the lowest costs (no need to screen for HCV). The incremental cost utility of option B over C was $13,954 (present value 1990)/QALY. This economic appraisal suggests that transplanting HCV-infected kidneys into infected recipients is superior to a discard policy from both a cost and patient outcome perspective. However, other overriding factors, such as the ethical dilemma of transplanting an infected organ, must be addressed by both physician and patient/public before a consensus can be reached.