*Purpose: We assessed the cost savings generated by additional organ availability due to utilizing lungs from hepatitis-C infected donors for transplantation in comparison to existing lung transplantation practice. By increasing organ availability and transplanting at lower LAS scores, healthcare costs could be reduced.

*Methods: We developed a Markov model using Monte Carlo microsimulation to obtain cost estimates for 1, 3, and 5-year timeframes for patients starting from the time of listing for lung transplantation. We included two arms, one for usual lung transplantation practice and an intervention arm allowing for 7% increased organ availability with acceptance of hepatitis C positive lung donation. Health states were stratified by four LAS categories: <40, ≥40 to <60, ≥60 to <80, and ≥80. Patients were allowed to move between LAS categories prior to transplantation. Model parameters, such as probabilities and costs, were obtained from existing literature on lung transplantation and internal lung transplant registries, supplemented by additional cost data from our practice. We simulated 100,000 hypothetical patients, with the model representing the average adult patient listed for a first lung transplant. Costs were valued in 2018 US Dollars. Future costs were discounted at 3% annually.

*Results: Mean costs of hepatitis C positive lung donation after 1 year is $166,944 compared with standard of care cost of $163,759, after 3 years is $217,120 compared with standard of care $216,430, and after 5 years is $218,031 compared with standard of care 5-year cost of $218,386. At each 1, 3, and 5-year time point, percentage of transplants increased using hepatitis C positive organs and percent deaths pre-transplant were reduced. Mean months alive were the same at 1, 3, and 5-years with increased organ availability. Time spent awaiting transplantation was reduced at each time point compared with standard of care. The biggest decreases in cost compared to standard of care were seen at LAS scores 60 to <80 and ≥80 at the 3 and 5-year time point.

*Conclusions: Use of lungs from donors infected with hepatitis C for transplantation increases organ availability and reduces wait time at a similar cost compared with existing lung transplantation practices. Cost savings are produced with longer timeframes, particularly as LAS score increases.

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