Transplanting Hepatitis C Virus-Infected Versus Uninfected Kidneys Into Hepatitis C Virus-Infected Recipients: A Cost-Effectiveness Analysis.
Ann Intern Med
; 169(4): 214-223, 2018 08 21.
Article
em En
| MEDLINE
| ID: mdl-29987322
ABSTRACT
Background:
Direct-acting antiviral agents are now available to treat chronic hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD).Objective:
To examine whether it is more cost-effective to transplant HCV-infected or HCV-uninfected kidneys into HCV-infected patients.Design:
Markov state-transition decision model. Data Sources MEDLINE searches and bibliographies from relevant English-language articles. Target Population HCV-infected patients with ESRD receiving hemodialysis in the United States. Time Horizon Lifetime. Perspective Health care system. Intervention Transplant of an HCV-infected kidney followed by HCV treatment versus transplant of an HCV-uninfected kidney preceded by HCV treatment. OutcomeMeasures:
Effectiveness, measured in quality-adjusted life-years (QALYs), and costs, measured in 2017 U.S. dollars. Results of Base-CaseAnalysis:
Transplant of an HCV-infected kidney followed by HCV treatment was more effective and less costly than transplant of an HCV-uninfected kidney preceded by HCV treatment, largely because of longer wait times for uninfected kidneys. A typical 57.8-year-old patient receiving hemodialysis would gain an average of 0.50 QALY at a lifetime cost savings of $41 591. Results of SensitivityAnalysis:
Transplant of an HCV-infected kidney followed by HCV treatment continued to be preferred in sensitivity analyses of many model parameters. Transplant of an HCV-uninfected kidney preceded by HCV treatment was not preferred unless the additional wait time for an uninfected kidney was less than 161 days.Limitation:
The study did not consider the benefit of decreased HCV transmission from treating HCV-infected patients.Conclusion:
Transplanting HCV-infected kidneys into HCV-infected patients increased quality-adjusted life expectancy and reduced costs compared with transplanting HCV-uninfected kidneys into HCV-infected patients. Primary Funding Source Merck Sharp & Dohme and the National Center for Advancing Translational Sciences.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Antivirais
/
Doadores de Tecidos
/
Transplante de Rim
/
Análise Custo-Benefício
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Hepatite C Crônica
/
Falência Renal Crônica
Tipo de estudo:
Diagnostic_studies
/
Health_economic_evaluation
/
Prognostic_studies
Limite:
Humans
/
Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article