Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients

Abstract

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.

Effect of Hepatitis C donor status on heart transplantation outcomes in the United States

“…In a prospective study of 44 HCV‐uninfected HT and/or lung transplant recipients who received an organ from an HCV‐infected donor, preemptive sofosbuvir‐velpatasvir given for four weeks prevented the development of HCV infection in the recipients for the six‐month follow‐up period in all patients 2 . A more recent cost‐effectiveness analysis between cohorts of transplant recipients willing and unwilling to receive HCV‐viremic hearts showed that willingness to accept HCV‐viremic hearts for HT into HCV‐negative recipients was cost‐effective and accepting any heart remained cost‐effective provided post‐transplant mortality among those receiving HCV‐viremic hearts was not >7% higher compared to HCV− hearts 6 . Given the large pool of HCV+ donors in the setting of opioid overdose epidemic, 7,8 and based on the promising results described above, the transplantation of HCV+ organs may allow shorter waitlist time with similar post‐operative outcomes.…”

“…2 A more recent cost-effectiveness analysis between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts showed that willingness to accept HCV-viremic hearts for HT into HCV-negative recipients was cost-effective and accepting any heart remained cost-effective provided post-transplant mortality among those receiving HCV-viremic hearts was not >7% higher compared to HCV− hearts. 6 Given the large pool of HCV+ donors in the setting of opioid overdose epidemic, 7,8 and based on the promising results described above, the transplantation of HCV+ organs may allow shorter waitlist time with similar post-operative outcomes. Furthermore, our findings support the hypothesis that HCV+ HT does not affect negatively short-term and one-year survival of HT recipients as also suggested by Madan and colleagues.…”

The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients

“…Logan et al conducted a Markov model-based analysis that projected that transplanting HCV+ hearts would be cost-effective for adults waitlisted for heart transplant with a durable VAD or intravenous inotropes. 13 We build on this study using a microsimulation model-based analysis, which permits individual patient simulation and time-varying inputs and outcomes (eg, waitlist time and costs), and found that donating HCV+ hearts would be cost-effective for all heart transplant candidates in the US. A second model-based analysis by Wayda et al used national datasets to model the impact of universal HCV+ heart donation for all waitlist candidates between 2014 and 2019, detailing the cost-effectiveness and policy implications of transplanting HCV+ hearts in a real-world cohort.…”

Current status and outcomes in heart transplantation: a narrative review

“…Transmission of HCV viremia after HTx is reportedly 95.7-100% in recipients of NAT+ donor hearts over a median of 5 days (range of 1-14 days), while none of the recipients of NAT-donor hearts acquired HCV viremia [68,69]. Providing DAA therapy after accepting allografts from HCV donors seems to be more cost effective in the overall care of end-stage heart failure than not accepting HCV organs [70]. The International Society for Heart and Lung Transplantation (ISHLT) consensus of 2020 recommends routine testing for recipient HCV status and either a prophylactic or a preemptive approach to managing donor-derived HCV infection [62].…”