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HCV treatments increase amount of spared livers for transplantation

Treating and curing hepatitis C virus infection with direct-acting antivirals may increase the number of livers spared for transplantation that can be allocated to patients with other forms of liver disease who may need them, according to new data published in The American Journal of Managed Care.

“The inadequate supply of liver donors in the United States is a real problem,” Anupam B. Jena, MD, PhD, associate professor of health care policy at Harvard Medical School and an internist at Massachusetts General Hospital, said in a press release. “People die every day of liver disease because a suitable organ never materializes. By curing patients of HCV before they become sick enough to need a new liver, new HCV drugs shorten the waiting lists and make more livers available to patients with other illnesses.”

Anupam B. Jena

Using data from the NHANES and UNOS databases, Jena and colleagues developed an epidemiologic-economic model to estimate how a systematic HCV screening and treatment program would reduce the number of livers transplanted into patients with HCV and end-stage liver disease and increase the number of spared livers that could be transplanted into patients with other forms of ESLD.

Real-world and comprehensive HCV screening and treatment techniques were compared from a baseline in which the screening and treatment did not change from the status quo. The researchers made projections on the annual demand for HCV-mediated liver transplants and non-mediated liver transplants, annual number of patients receiving a transplant, used incidence forecasts to project the number of HCV-mediated and non-mediated patients receiving a transplant, projected the supply of livers available for transplantation based on the population between 2015 and 2035 and estimated the economic value of the gains by applying a $150,000 value per life-year.

“We estimated that the treatment of HCV by novel direct-acting antiviral therapies may have large, positive spillovers by reducing the future number of liver transplants to patients with HCV, thus sparing livers for transplants into other patients with end-stage liver disease,” the researchers wrote.

Under the real-world scenario, the projected number of patients with HCV and decompensated liver failure was 30% lower and mortality due to liver disease was 22% lower compared with baseline. The total number of new patients with HCV being added to the transplant list between 2015 and 2035 was 28% lower under the real-world program.

The researchers’ model predicted that 45,541 livers would be transplanted into patients with HCV between 2015 and 2035 at baseline compared with 35,052 under the real-world scenario.

A total of 7,321 spared liver transplants were allocated to patients without HCV and 3,169 spared liver transplants were allocated to patients with uncured HCV.

The total life-years gained from additional transplants in each group were projected to be 52,711 years and 22,817 years, according to the research.

“This amounts to $7.9 billion in economic value accrued to patients with non-HCV-mediated liver disease over this time period, with an additional $3.5 billion accruing to patients with HCV,” the researchers wrote.

Further analysis addressed future trends in other liver diseases, such as nonalcoholic fatty liver disease, and its effect on spared livers. The researchers found that increasing trends in NAFLD and liver disease due to alcohol and or iron/copper deposition would increase the total number of spared livers allocated to patients from 7,321 to 7,653 between 2015 and 2035. The researchers noted that the use of an opt-out policy for organ donation would further increase this number from 7,653 to 10,953 and a comprehensive HCV screening and treatment intervention would increase the number from 10,953 to 16,557.

“Our findings highlight a novel mechanism by which positive disease spillovers occur when the same scarce resource — in this case transplantable organs — applies to multiple diseases,” the researchers concluded. “Our analyses suggest that because the outcomes of patients with various forms of ESLD are linked by the scarcity of liver transplants, a systematic HCV screening and treatment program in the United States could substantially improve transplant opportunities and outcomes for patients with ESLD from causes other than HCV.” – by Melinda Stevens

Disclosure: Jena reports consulting for Precision Health Economics. Please see the full study for a list of all other researchers’ relevant financial disclosures.  

Photo Credit: Steve Lipofsky.