Background

The advent of direct-acting antiviral therapy for Hepatitis C (HCV) has made using HCV-viremic donors a viable strategy to address the donor shortage in heart transplantation. We employed a large-scale simulation to evaluate the impact and cost-effectiveness of using HCV-viremic donors for heart transplant.

Methods

We simulated detailed histories from time of listing until death for the real-world cohort of all adults listed for heart transplant in the United States from July 2014 to June 2019 (n = 19,346). This population was imputed using historical data and captures “real-world” heterogeneity in geographic and clinical characteristics. We estimated the impact of an intervention in which all candidates accept HCV+ potential donors (n = 472) on transplant volume, waitlist outcomes, and lifetime costs and quality-adjusted life years (QALYs).

Results

The intervention produced 232 more transplants, 132 fewer delistings due to deterioration, and 50 fewer waitlist deaths within this 5-year cohort and reduced wait times by 3% to 11% (varying by priority status). The intervention was cost-effective, adding an average of 0.08 QALYs per patient at a cost of $124 million ($81,892 per QALY). DAA therapy and HCV care combined account for 11% this cost, with the remainder due to higher costs of transplant procedures and routine post-transplant care. The impact on transplant volume varied by blood type and region and was correlated with donor-to-candidate ratio (ρ = 0.71).

Conclusions

Transplanting HCV+ donor hearts is likely to be cost-effective and improve waitlist outcomes, particularly in regions and subgroups experiencing high donor scarcity.

中文翻译：

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使用丙型肝炎病毒血症供体进行心脏移植的成本效益和全系统影响

 背景

丙型肝炎 (HCV) 直接作用抗病毒疗法的出现，使得使用 HCV 病毒血症供体成为解决心脏移植供体短缺问题的可行策略。我们采用大规模模拟来评估使用 HCV 病毒血症供体进行心脏移植的影响和成本效益。

 方法

我们模拟了 2014 年 7 月至 2019 年 6 月美国列出的所有接受心脏移植的成年人的真实队列（n = 19,346）从列出时间到死亡的详细历史。该人群使用历史数据进行估算，并捕捉地理和临床特征的“现实世界”异质性。我们估计了所有候选者接受 HCV+ 潜在捐赠者 (n = 472) 的干预措施对移植量、候补结果、终生成本和质量调整生命年 (QALY) 的影响。

 结果

在这 5 年队列中，干预措施增加了 232 例移植手术，减少了 132 例因病情恶化而被除名的病例，减少了 50 例候补死亡病例，并将等待时间缩短了 3% 至 11%（根据优先状态而异）。该干预措施具有成本效益，平均为每位患者增加 0.08 QALY，成本为 1.24 亿美元（每个 QALY 81,892 美元）。 DAA 治疗和 HCV 护理合计占该成本的 11%，其余部分是由于移植手术和常规移植后护理的成本较高。对移植量的影响因血型和地区而异，并且与供体与候选者的比率相关（ρ = 0.71）。

 结论

移植 HCV+ 供体心脏可能具有成本效益，并且可以改善候补名单的结果，特别是在供体严重短缺的地区和亚群体。