Background: The development of direct acting antiviral (DAA) therapy for hepatitis C virus (HCV) could allow for safe and effective treatment following renal transplantation (RT). Early pilot studies have shown that transplanting HCV D+ organs into HCV – recipients (R-), thus reducing wait list and time on dialysis (HD), then treating HCV with DAA results in high sustained virologic response. However, the cost effectiveness of such a strategy is unknown.

Methods: A decision tree model was developed to analyze costs and effectiveness of a 5-year time frame between two choices: RT using a D+/R- strategy compared to continuing HD and waiting for a HCV- donor (D-/R-). We assessed the payers perspective using data from the United States Renal Data System (USRDS) 2016 Annual Report. Effectiveness was measured by expected years of life (YOL). Costs included direct expenditure for RT and immediate care post-RT, immunosuppressive therapy, HD and costs while awaiting RT, and HCV with 12 weeks of DAA for D+/R- patients. Medicaid national average drug acquisition cost was used to estimate HCV treatment costs. A total of 13 chance paths were modeled with an endpoint of two possible outcomes: death or alive. Patients on dialysis waiting for RT were examined at years 1, 2, 3, and 4 during the 5 year time frame.

Results: The strategy of accepting a HCV+ organ then treating HCV (D+/R-) resulted in an expected 4.6 YOL with an expected cost of $154k US dollars compared to an expected 3.6 YOL with a total cost of $257k for the D-/R- strategy. The D+/R- strategy remained dominant after one-way sensitivity analyses including adjustment for RT survival probability, DAA therapy cure rate (90-95%), waiting time on dialysis in the D+/R- strategy (0-12 months), cost of DAA treatment ($37,538-$73,618), probability of dialysis patients getting a RT in the D-/R- strategy by year (25% @ Y1, 50% @ Y2, 75% @ Y3, and 100% @ Y4 vs. base case of 0% @ Y1, 25% @ Y2, 50% @ Y3, 75% @ Y4, and 100% @ Y5), and HD survival probability while awaiting RT in the D-/R- strategy (± 20% of base value).

Conclusions: The utilization of HCV D+ kidneys into HCV – RT recipients then treating the HCV with DAA is less costly and more effective with increased expected years of life compared to the D-/R- strategy. This D+/R- strategy should result in fewer discarded organs, reducing the time on dialysis and increasing the number of patients undergoing RT.

CITATION INFORMATION: Gupta G., Zhang Y., Kale H., Carroll N., Sterling R. Cost Effectiveness of Hepatitis C Positive Donor Kidney Transplantation for Hepatitis C Negative Recipients with Concomitant Direct-Acting Anti-Viral Therapy Am J Transplant. 2017;17 (suppl 3).

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