Transplanting Hepatitis C Virus–Infected Versus Uninfected Kidneys Into Hepatitis C Virus–Infected Recipients A Cost-Effectiveness Analysis

Background:

Direct-acting antiviral agents are now available to treat chronic hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD).

Objective:

To examine whether it is more cost-effective to transplant HCV-infected or HCV-uninfected kidneys into HCV-infected patients.

Design:

Markov state-transition decision model.

Data Sources:

MEDLINE searches and bibliographies from relevant English-language articles.

Target Population:

HCV-infected patients with ESRD receiving hemodialysis in the United States.

Time Horizon:

Lifetime.

Perspective:

Health care system.

Intervention:

Transplant of an HCV-infected kidney followed by HCV treatment versus transplant of an HCV-uninfected kidney preceded by HCV treatment.

Outcome Measures:

Effectiveness, measured in quality-adjusted life-years (QALYs), and costs, measured in 2017 U.S. dollars.

Results of Base-Case Analysis:

Transplant of an HCV-infected kidney followed by HCV treatment was more effective and less costly than transplant of an HCV-uninfected kidney preceded by HCV treatment, largely because of longer wait times for uninfected kidneys. A typical 57.8-year-old patient receiving hemodialysis would gain an average of 0.50 QALY at a lifetime cost savings of $41 591.

Results of Sensitivity Analysis:

Transplant of an HCV-infected kidney followed by HCV treatment continued to be preferred in sensitivity analyses of many model parameters. Transplant of an HCV-uninfected kidney preceded by HCV treatment was not preferred unless the additional wait time for an uninfected kidney was less than 161 days.

Limitation:

The study did not consider the benefit of decreased HCV transmission from treating HCV-infected patients.

Conclusion:

Transplanting HCV-infected kidneys into HCV-infected patients increased quality-adjusted life expectancy and reduced costs compared with transplanting HCV-uninfected kidneys into HCV-infected patients.

Primary Funding Source:

Merck Sharp & Dohme and the National Center for Advancing Translational Sciences.

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