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

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

Quality-adjusted life years and surgical waiting list: Systematic review of the literature

“…For example, six of the studies aimed to measure the cost-effectiveness of increasing the organ pool by accepting the transplant of a hepatitis C virus-positive organ in hepatitis C virus-negative recipients, with appropriate antiviral treatment. All the studies reported increases in QALYs and reductions of the waiting lists with this strategy and considered it to be cost-effective despite the added cost of the antivirals[ 7 - 12 ]. Another strategy for expanding the organ pool involved the introduction of organs from cardiac death donors as well as from brain dead donors.…”

Relationship between hepatitis C virus аnd cardiovascular disease

“…Расчеты показывают экономическую эффективность и улучшение клинических исходов среди ВГС-отрицательных пациентов, принявших сердце от инфицированного донора [49][50][51]. Запрет на проведение трансплантаций сердца от ВГС-инфицированных доноров связан с риском инфицирования реципиентов ВГС, которое в случае забора трансплантата от донора с вирусемией (HCVAb+РНК+) и отсутствия последующей ПВТ реципиента происходило практически всегда [52] и сопровождалось развитием васкулопатии трансплантата, плохой выживаемостью трансплантата и реципиента [53,54].…”