Cost Effectiveness of Transplanting HCV-Infected Livers Into Uninfected Recipients With Preemptive Antiviral Therapy.
Cost Effectiveness of Transplanting HCV-Infected Livers Into Uninfected Recipients With Preemptive Antiviral Therapy.
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DOI：
10.1016/j.cgh.2018.08.042
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发表时间：
2019-03
期刊：
影响因子：
--
通讯作者：
Chhatwal J
中科院分区：
文献类型：
--
作者：
Bethea ED;Samur S;Kanwal F;Ayer T;Hur C;Roberts MS;Terrault N;Chung RT;Chhatwal J
指南不建议将丙型肝炎病毒（HCV）感染的肝脏移植到未感染HCV的受体中。直接作用抗病毒药物（DAA）可用于治疗供体来源的HCV感染。然而，DAA治疗的额外费用是一个障碍。我们评估了将HCV阳性肝移植到HCV阴性患者中的成本效益，并采用先发制人的DAA治疗。一个先前验证的马尔可夫为基础的数学模型，适用于模拟虚拟试验的HCV阴性患者的肝移植等待名单。该模型比较了只愿意接受HCV阴性肝脏的患者与愿意接受任何（HCV阴性或HCV阳性）肝脏的患者的长期临床和经济结局。HCV阳性肝脏的接受者接受了12周的抢先DAA治疗。该模型结合了来自器官共享联合网络和已发表来源的数据。对于终末期肝病模型（MELD）评分≥ 22的患者，接受任何肝脏与仅等待HCV阴性肝脏相比具有成本效益，增量成本效益比范围为56，100美元至91，700美元/质量调整生命年。对于MELD评分为28（美国接受移植患者的MELD评分中位数）的患者，接受任何肝脏都具有成本效益，增量成本效益比为62，600美元/质量调整生命年。在MELD评分较低的患者中，可能无法准确反映疾病的严重程度，接受任何肝脏都具有成本效益，无论MELD评分如何。使用基于马尔可夫的数学模型，我们发现在HCV阴性患者中移植HCV阳性肝脏并进行先发制人的DAA治疗是一种具有成本效益的策略，可以改善健康状况。
Guidelines do not recommend transplanting hepatitis C virus (HCV)-infected livers into HCV-uninfected recipients. Direct-acting antivirals (DAAs) can be used to treat donor-derived HCV infection. However the added cost of DAA therapy is a barrier. We evaluated the cost effectiveness of transplanting HCV-positive livers into HCV-negative patients with preemptive DAA therapy. A previously validated Markov-based mathematical model was adapted to simulate a virtual trial of HCV-negative patients on the liver transplant waitlist. The model compared long-term clinical and economic outcomes in patients willing to accept only HCV-negative livers vs those willing to accept any (HCV-negative or HCV-positive) liver. Recipients of HCV-positive livers received 12 weeks of preemptive DAA therapy. The model incorporated data from the United Network for Organ Sharing and published sources. For patients with a model for end-stage liver disease (MELD) score ≥ 22, accepting any liver vs waiting for only HCV-negative livers was cost effective, with incremental cost-effectiveness ratios ranging from $56,100 to $91,700/quality-adjusted life year. For patients with a MELD score of 28 (the median MELD score of patients undergoing transplantation in the United States), accepting any liver was cost effective at an incremental cost-effectiveness ratio of $62,600/quality-adjusted life year. In patients with low MELD scores that may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score. Using a Markov-based mathematical model, we found transplanting HCV-positive livers in HCV-negative patients with preemptive DAA therapy to be a cost-effective strategy that could improve health outcomes.
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融合了等待列表结果的例外和速率。
DOI：
10.1111/j.1600-6143.2011.03735.x
发表时间：
2011-11
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Massie AB;Caffo B;Gentry SE;Hall EC;Axelrod DA;Lentine KL;Schnitzler MA;Gheorghian A;Salvalaggio PR;Segev DL
通讯作者：
Segev DL
影响因子：
9.8
作者：
Chong, CAKY;Gulamhussein, A;Krahn, M
通讯作者：
Krahn, M
DOI：
10.1002/hep.29723
发表时间：
2018-06
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Chhatwal J;Samur S;Bethea ED;Ayer T;Kanwal F;Hur C;Roberts MS;Terrault N;Chung RT
通讯作者：
Chung RT
影响因子：
2.1
作者：
Kling, Catherine E.;Limaye, Ajit P.;Sibulesky, Lena
通讯作者：
Sibulesky, Lena
影响因子：
13.5
作者：
Chhatwal, Jagpreet;Samur, Sumeyye;Chung, Raymond T.
通讯作者：
Chung, Raymond T.