Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients.
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.
['Logan|Cathy|C|0000-0002-3895-952X', 'Yumul|Ily|I|0000-0001-5579-2410', 'Cepeda|Javier|J|0000-0003-0304-3172', 'Pretorius|Victor|V|0000-0001-6360-4002', 'Adler|Eric|E|0000-0002-4765-0188', 'Aslam|Saima|S|0000-0002-4051-5629', 'Martin|Natasha K|NK|0000-0001-8344-1810']
D000998:Antiviral Agents D003362:Cost-Benefit Analysis D016174:Hepacivirus D006526:Hepatitis C D006801:Humans D014766:Viremia
clinical research/practice economics health services and outcomes research heart transplantation/cardiology infection and infectious agents - viral: hepatitis C infectious disease mathematical model organ acceptance organ procurement and allocation