Given that Hepatitis C (HCV) can be cured, organs from HCV+ deceased donors might be used even in HCV- recipients. However HCV treatment is expensive. The purpose of this analysis is to determine whether this strategy is cost effective from the third party payer perspective.

US mortality rates for adult wait-listed, functioning transplant and dialysis cohorts and graft survival rates were used for waitlisted subjects (baseline age 40). Baseline annual dialysis ($82,338), annual transplant ($25,584), first year transplant ($118,669) and one time HCV treatment ($75,000) costs were incorporated into the model. Time 0 was the date of listing, time horizon was 50 years and costs (US$) and life years were discounted at 3%.

Option 1 patients on the waitlist would only opt to be transplanted with a HCV- organ (5 years average wait) only. Option 2 patients would opt to receive either a HCV- or HCV+ organ with the hope of an earlier transplant (average wait 4 years).

The Table shows a 1-way sensitivity analysis that incorporated the possibility that some of those receiving a HCV+ organ might fail therapy. If there was 0% chance of treatment failure then Option2 resulted in more life years at less cost. If 5% of those receiving a HCV+ organ failed treatment, then the benefits were lower and the costs higher with an incremental costs/life year of about $58,000. If the risk of treatment failure remained less than 3%, then Option 2 resulted in more life years at less cost.

If HCV treatment cost was higher ($150,000 vs. $75,000), Option2 would still be cost effective (incr. cost/life year of <$100,000) except in older patients (>age 60) who had an incr. cost/life year exceeding $200,000. Incr. cost/life year increased if overall wait times for HCV- organs were shorter or risk of treatment failure increased.

The cost effectiveness of this strategy depends more on a high likelihood of cure rather than HCV treatment costs.

CITATION INFORMATION: Kiberd B, Doucette K, Tennankore K. Use of Hepatitis C Infected Organs for Kidney Transplantation: A Cost-Effective Analysis. Am J Transplant. 2017;17 (suppl 3).

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