HCV-Positive Liver Transplant Proven To Be Cost Effective

Jagpreet Chhatwal, PhD

As evidence mounts that it’s safe to transplant the livers of hepatitis C (HCV)-positive donors into HCV-negative patients, a new study finds the practice is also more cost-effective than waiting for a non-HCV-infected donor liver.

Researchers from the University of Pennsylvania earlier this year announced findings showing that patients who received a liver transplant from an HCV-infected donor could be cured of HCV and that their new livers would function just as well as livers donated by HCV-negative patients. New research is now adding to the conversation.

Scientists from several US academic medical institutions have published a study showing that it’s cost-effective to use the livers of HCV-positive patients. Cost is a major issue because the price for direct-acting antiviral therapy is upwards of $100,000, and a recent study found that in about half of cases, HCV-positive patients are denied coverage for DAAs.

“The added cost of DAA in this setting remains a logistical barrier,” Jagpreet Chhatwal, PhD, the corresponding author on the new cost-effectiveness study, told MD Magazine®. “Payers currently do not approve DAA treatment for patients who acquire HCV infection resulting from an HCV-positive liver transplant.”

For their study, Chhatwal and colleagues looked specifically at costs and benefits when patients receiving HCV-positive livers were given pre-emptive direct-acting antiviral (DAA) therapy. The team adapted a Markov-based mathematical model to conduct a “virtual trial” of patients on the national liver transplant waiting list. The cost was calculated based on 12 weeks of DAA therapy.

Among patients with a score of 22 or above on the model end-stage liver disease (MELD) scale, accepting any available liver (even if it meant needing DAA therapy) was found to be cost-effective, with incremental cost-effectiveness ratios ranging from $56,1000 to $91,700 per quality-adjusted life year (QALY), the investigators wrote. Among patients with the median MELD score of US transplant recipients (28) the incremental cost-effectiveness ratio was was $62,600 per QALY.

“In patients with low MELD scores that may not accurately reflect disease severity, accepting any liver was cost effective, irrespective of MELD score,” investigators concluded.

Chhatwal noted that, while DAA use will result in an increase in initial spending, it is an advantageous long-term investment for the benefit of health outcomes and cost savings.

“Therefore, we believe these results can be used to inform policy and support coverage for this new use of therapy,” Chhatwal said.

It’s hard to know exactly what impact it would have if hospitals and insurers began embracing the idea of using livers from HCV-positive donors.

“However, in the long-run we expect that the supply of HCV-positive livers will increase because of ongoing opioid epidemic and the number of HCV-positive transplant candidates will decrease substantially because of the availability of DAAs,” Chhatwal said. “Therefore, HCV-positive livers could potentially go wasted in future, if these organs are not utilized by HCV-negative recipients.”

The study, “Cost-effectiveness of Transplanting HCV-Infected Livers into Uninfected Recipients with Preemptive Antiviral Therapy,” was published in Clinical Gastroenterology and Hepatology.