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Cost‐effectiveness of using hepatitis C viremic hearts for transplantation into HCV‐negative recipients
Author(s) -
Logan Cathy,
Yumul Ily,
Cepeda Javier,
Pretorius Victor,
Adler Eric,
Aslam Saima,
Martin Natasha K.
Publication year - 2021
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.16245
Subject(s) - medicine , heart transplantation , hepatitis c virus , hepatitis c , cost effectiveness , transplantation , intensive care medicine , quality adjusted life year , liver transplantation , immunology , virus , risk analysis (engineering)
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.