Transplanting kidneys from donors with hepatitis C virus into uninfected recipients reduced costs to the health care system, while also increasing life expectancy for recipients, according to this study.
“Less than 4% of patients with kidney failure receive kidney transplants,” Mark H. Eckman, MD, MS, of the University of Cincinnati, and colleagues wrote. “Although discard rates of hepatitis C virus (HCV)-viremic kidneys are declining, [about] 39% of HCV-viremic kidneys donated between 2018 and 2019 were discarded.”
As antiviral agents to successfully treat the infection are now available, the researchers examined the financial impact of transplanting such kidneys into uninfected recipients using a computer simulation model. They wrote that their cost analyses were performed from the health care system perspective and “did not include indirect costs, such as those associated with patients’ lost time from work.” Effectiveness was further measured in quality-adjusted life-years (QALYs).
Outcomes were compared between transplantation with an HCV-unexposed kidney and transplantation with an HCV-viremic kidney with HCV treatment. Researchers noted efficacy was calculated based on median waitlist times (average wait time 4 years for HCV-unexposed vs. 1.56 years for HCV-exposed kidneys).
They found transplantation with an infected kidney improved survival by 1.19 QALYs. In addition, the researchers considered the possibility of longer waitlist times for an HCV-exposed kidney. A sensitivity analysis suggested that as long as the average waitlist time is less than 3.1 years, transplantation with an HCV-viremic kidney will continue to provide gains to quality-adjusted survival.
After conducting the economic analysis, transplantation with an HCV-viremic kidney led to a lifetime cost savings of $37,918.
Researchers wrote that the opioid epidemic has increased the number of potential donors who are younger and have few other comorbid conditions and that these kidneys should be considered for transplantation.
However, they emphasized that because waiting times vary substantially between patients and centers, it is plausible that the transplantation of HCV-viremic kidneys into patients with shorter wait times for unexposed kidneys would not result in a net benefit.
Therefore they argued, “What is needed is a decision support tool that can aid patients and their physicians in making the best choice, based on waiting times for both HCV-unexposed and HCV-viremic kidneys using patient-specific clinical, demographic and center-specific information.” – by Melissa J. Webb
