The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients.
The Cost-effectiveness of Transplanting Hearts From Hepatitis C-infected Donors Into Uninfected Recipients.
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DOI：
10.1097/tp.0000000000004378
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发表时间：
2023-04-01
期刊：
影响因子：
6.2
通讯作者：
中科院分区：
文献类型：
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作者：
DONATE HCV 试验证明了丙型肝炎病毒血症 (HCV+) 捐赠者心脏移植的安全性和有效性。在本报告中，我们研究了美国普遍 HCV+ 心脏捐赠者资格对移植等待时间和预期寿命的成本效益和影响。我们开发了一个微观模拟模型来比较 2018 年心脏移植候选者的 2 种候补策略：(1) 现状 (SQ) 和 (2) SQ 加 HCV+ 捐赠者 (SQ + HCV)。根据 DONATE HCV 试验和已发布的国家数据集，我们对平均年龄（53 岁）、男性（75%）、候补死亡率（0.01-0.10/月）和移植概率（0.03-0.21/月）按医疗紧急程度分层，以及移植后死亡率（0.003-0.052/月）进行了建模。我们假设与 SQ 相比，SQ + HCV 的移植量增加 23%。费用（2018 美元）包括候补护理（2200-190 000 美元/月）、移植（213 400 美元）、4 周 HCV 治疗（26 000 美元）和移植后护理（2500-11 300 美元/月）。我们预测了候补时间、质量调整生命年 (QALY)、终生成本和增量成本效益比 (ICER [$/QALY，折扣 3%/年]；阈值 ≤ $100 000/QALY)。与 SQ 相比，SQ + HCV 将候补时间从 8.7 个月减少到 6.7 个月，将未折扣预期寿命从 8.9 QALY 增加到 9.2 个 QALY，并将折扣终生费用从 671 400 美元/人增加到 690 000 美元/人。四周的 HCV 治疗占终生费用的 0.5%。与 SQ 相比，SQ + HCV 的 ICER 为 74 100 美元/QALY，并保持 ≤ 100 000 美元/QALY，移植和移植后费用增加高达 30%。移植来自感染 HCV 的捐献者的心脏可以减少等待时间，延长预期寿命，并且具有成本效益。在当前丙肝治疗费用高昂的背景下，这些发现是有力的。
The DONATE HCV trial demonstrated the safety and efficacy of transplanting hearts from hepatitis C viremic (HCV+) donors. In this report, we examine the cost-effectiveness and impact of universal HCV+ heart donor eligibility in the United States on transplant waitlist time and life expectancy. We developed a microsimulation model to compare 2 waitlist strategies for heart transplant candidates in 2018: (1) status quo (SQ) and (2) SQ plus HCV+ donors (SQ + HCV). From the DONATE HCV trial and published national datasets, we modeled mean age (53 years), male sex (75%), probabilities of waitlist mortality (0.01–0.10/month) and transplant (0.03–0.21/month) stratified by medical urgency, and posttransplant mortality (0.003–0.052/month). We assumed a 23% increase in transplant volume with SQ + HCV compared with SQ. Costs (2018 United States dollar) included waitlist care ($2200–190 000/month), transplant ($213 400), 4-wk HCV treatment ($26 000), and posttransplant care ($2500–11 300/month). We projected waitlist time, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs [$/QALY, discounted 3%/year]; threshold ≤$100 000/QALY). Compared with SQ, SQ + HCV decreased waitlist time from 8.7 to 6.7 months, increased undiscounted life expectancy from 8.9 to 9.2 QALYs, and increased discounted lifetime costs from $671 400/person to $690 000/person. Four-week HCV treatment comprised 0.5% of lifetime costs. The ICER of SQ + HCV compared with SQ was $74 100/QALY and remained ≤$100 000/QALY with up to 30% increases in transplant and posttransplant costs. Transplanting hearts from HCV-infected donors could decrease waitlist times, increase life expectancy, and be cost-effective. These findings were robust within the context of current high HCV treatment costs.