1. Use of HCV-infected kidneys increased patients’ quality-adjusted life expectancy.
2. Lower costs were associated with HCV-infected kidneys compared to transplanting HCV-uninfected kidneys to HCV-positive patients.
Evidence Rating Level: 2 (Good)
Study Rundown: Organ availability for transplantation is limited; therefore, for patients with end stage renal disease (ESRD), hemodialysis is often the final treatment compared to transplantation. Due to the limitation of kidneys for transplant, some physicians have considered using organs that might not otherwise be considered. Due to HCV treatments that are now available, it is possible for HCV-infected patients to receive HCV-infected kidneys in transplantation. This study assessed whether it is more cost-effective to utilize HCV-infected kidneys, compared to treating HCV patients first and then transplanting an HCV-uninfected kidney. This study had several limitations. Of note, it did not consider the potential benefit of decreased HCV transmission from treating HCV-infected patients before kidney transplantation. Furthermore, the study did not consider other patient comorbidities beyond chronic HCV infection.
In-Depth [cost-effectiveness analysis]: The authors of the study conducted a cost-effectiveness analysis to determine whether it is beneficial to transplant HCV-infected versus HCV-uninfected kidneys into HCV-inducted patients. A Markov state-transition decision model was utilized, and data was retrieved from MEDLINE searches and reference lists. The authors observed that using HCV-infected kidneys was a cost-effective intervention for patients already infected with HCV. Using an HCV-infected kidney and deferring treatment was more effective and less costly compared to using an HCV-uninfected kidney with HCV treatment prior to transplant. The annual cost savings of utilizing HCV-infected kidneys was $38 691 (SD $9141). Further, transplanting the HCV-infected kidneys also allowed for reduced wait times for transplantation and improved survival rates for patients already infected with HCV.
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