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HCV positive-to-negative kidney transplant cost-effective vs. waiting

Transplantation with hepatitis C nucleic acid test-positive kidneys in HCV-negative recipients followed by direct-acting antiviral therapy demonstrated improved patient outcomes and significant cost-savings, according to results of a recent modelling study.

“The findings indicate that it is cost-saving to consider the use of HCV NAT-positive kidneys for waitlist candidates in whom the waiting time for transplantation would be shortened by 2 years in the context of a clinical study,” Matthew Kadatz, MS, from the University of British Columbia in Vancouver, Canada, and colleagues wrote.

Kadatz and colleagues designed a model with a fixed cohort of adults without diabetes who were undergoing dialysis while on the waitlist for kidney transplantation to determine incremental cost-effectiveness (ICER) in dollars per quality-adjusted life year (QALY) from the health care payer perspective.

Using HCV NAT-positive kidneys resulted in increased QALYs at lower cost compared with remaining on the waitlist for 2, 3, 4 and 5 additional years for an HCV-negative kidney. Additionally, HCV NAT-positive kidney use was cost-effective with a willingness-to-pay threshold of $50,000 per QALY compared with waiting 1 year, in which the ICER was $56,018 per QALY with an additional incremental cost of $9,188.

Compared with waiting an additional year, the sensitivity analysis of HCV NAT-positive kidney use was robust, except for the cost of annual dialysis therapy and DAA therapy. However, when the cost of DAAs was decreased to 80% of market price, HCV NAT-positive kidney use was cost-saving from the health care payer perspective.

The cumulative health care payer cost at 5 years after use of an HCV NAT-positive kidney was lower ($310,099) compared with the cumulative cost for remaining on the waitlist for 2, 3, 4 and 5 years (range, $343,637-$469,306). The cumulative cost at 10 years was also lower ($421,656) compared with remaining on the waitlist for 2, 3, 4 and 5 years (range, $455,365-$567,627).

“Assuming 20 HCV NAT-positive kidneys were used in patients to shorten their wait-time by 2 to 5 years, this would potentially save the health care payer between $674,000 and $2.9 million over 10 years despite the increased upfront cost of providing DAAs,” Kadatz and colleagues wrote.

During a secondary analysis of cost-savings from the societal perspective, the researchers found that HCV NAT-positive kidney was preferable compared with remaining on the waitlist for 2 or more years. HCV NAT-positive kidney use had an ICER of $4,647 per QALY with an incremental cost of $762 compared with remaining on the waitlist for 1 year.

“The findings may encourage insurance providers to make the upfront investment in DAAs required to advance knowledge about this strategy that has significant potential to increase access to lifesaving kidney transplantation,” Kadatz and colleagues concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.