期刊
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
卷 17, 期 4, 页码 739-+出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2018.08.042
关键词
ICER; QALY; Viremic Donor; Prevention; Simulation Modeling
资金
- American Cancer Society [RSG-17-022-01-CPPB]
- Health Resources and Services Administration [234-2005-37011C]
- National Institutes of Health [DK078772]
- National Science Foundation [1722665, 1452999]
- Massachusetts General Hospital Research Scholars Program
- Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety [CIN 13-413]
- Public Health Service grant [P30DK05633]
- Direct For Computer & Info Scie & Enginr
- Div Of Information & Intelligent Systems [1722665] Funding Source: National Science Foundation
- Directorate For Engineering
- Div Of Civil, Mechanical, & Manufact Inn [GRANTS:13801401, 1452999] Funding Source: National Science Foundation
BACKGROUND & AIMS: Guidelines do not recommend transplanting hepatitis C virus (HCV)-infected livers into HCV-infected recipients. Direct-acting antivirals (DAAs) can be used to treat donor-derived HCV infection. However, the added cost of DAA therapy is a barrier. We evaluated the cost effectiveness of transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy. METHODS: A previously validated Markov-based mathematical model was adapted to simulate a virtual trial of HCV-negative patients on the liver transplant wait list. The model compared long-term clinical and economic outcomes in patients willing to accept only HCV-negative livers vs those willing to accept any liver (HCV negative or HCV positive). Recipients of HCV-positive livers received 12 weeks of preemptive DAA therapy. The model incorporated data from the United Network for Organ Sharing and published sources. RESULTS: For patients with a model for end-stage liver disease (MELD) score 22, accepting any liver vs waiting for only HCV-negative livers was cost effective, with incremental cost-effectiveness ratios ranging from $56,100 to $91,700/quality-adjusted life-year. For patients with a MELD score of 28 (the median MELD score of patients undergoing transplantation in the United States), accepting any liver was cost effective at an incremental cost-effectiveness ratio of $62,600/quality-adjusted life year. In patients with low MELD scores, which may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score. CONCLUSIONS: Using a Markov-based mathematical model, we found transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy to be a cost-effective strategy that could improve health outcomes.
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