The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients. Issue 4 (27th October 2022)

• Record Type: Journal Article
• Authors: Woolley, Ann E.; Gandhi, Aditya R.; Jones, Michelle L.; Kim, Jane J.; Mallidi, Hari R.; Givertz, Michael M.; Baden, Lindsey R.; Mehra, Mandeep R.; Neilan, and Anne M.
• Is Part Of: Transplantation. Volume 107:Issue 4(2023)
• Page Start: 961
• Page End: 969
• Publication Date: 2022-10-27
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000004378
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: The DONATE HCV trial demonstrated the safety and efficacy of transplanting hearts from hepatitis C viremic (HCV+) donors. In this report, we examine the cost-effectiveness and impact of universal HCV+ heart donor eligibility in the United States on transplant waitlist time and life expectancy. Methods: We developed a microsimulation model to compare 2 waitlist strategies for heart transplant candidates in 2018: (1) status quo (SQ) and (2) SQ plus HCV+ donors (SQ + HCV). From the DONATE HCV trial and published national datasets, we modeled mean age (53 years), male sex (75%), probabilities of waitlist mortality (0.01–0.10/month) and transplant (0.03–0.21/month) stratified by medical urgency, and posttransplant mortality (0.003–0.052/month). We assumed a 23% increase in transplant volume with SQ + HCV compared with SQ. Costs (2018 United States dollar) included waitlist care ($2200–190 000/month), transplant ($213 400), 4-wk HCV treatment ($26 000), and posttransplant care ($2500–11 300/month). We projected waitlist time, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs [$/QALY, discounted 3%/year]; threshold ≤$100 000/QALY). Results: Compared with SQ, SQ + HCV decreased waitlist time from 8.7 to 6.7 months, increased undiscounted life expectancy from 8.9 to 9.2 QALYs, and increased discounted lifetime costs from $671 400/person to $690 000/person. Four-week HCV treatment comprised 0.5% of lifetime costs. The ICER of SQ + HCV compared with SQ was $74 100/QALY and remained ≤$100 000/QALY with up to 30% increases in transplant and posttransplant costs. Conclusions: Transplanting hearts from HCV-infected donors could decrease waitlist times, increase life expectancy, and be cost-effective. These findings were robust within the context of current high HCV treatment costs.