Cost‐effectiveness of hepatitis C–positive donor kidney transplantation for hepatitis C–negative recipients with concomitant direct‐acting antiviral therapy

Pilot studies suggest that transplanting hepatitis C virus (HCV)–positive donor (D+) kidneys into HCV‐negative renal transplant (RT) recipients (R−), then treating HCV with direct‐acting antivirals (DAA) is clinically feasible. To determine whether this is a cost‐effective approach, a decision tree model was developed to analyze costs and effectiveness over a 5‐year time frame between 2 choices: RT using a D+/R− strategy compared to continuing dialysis and waiting for a HCV‐negative donor (D−/R−). The strategy of accepting a HCV+ organ then treating HCV was slightly more effective and substantially less expensive and resulted in an expected 4.8 years of life (YOL) with a cost of ≈$138 000 compared to an expected 4.7 YOL with a cost of ≈$329 000 for the D−/R− strategy. The D+/R− strategy remained dominant after sensitivity analyses including the difference in RT death probabilities or acute rejection probabilities between using D+ vs D− kidney; time that D−/R− patients waited for RT; dialysis death probabilities while waitlisted for RT in the D−/R− strategy; DAA therapy expected cure rate; costs of transplant, immunosuppressives, DAA therapy, dialysis, or acute rejection. The D+/R− strategy followed by treatment with DAA is less costly and slightly more effective compared to the D−/R− strategy.