Financial Evaluation of Kidney Transplant With Hepatitis C Viremic Donors to Uninfected Recipients

Transplantation Direct
David A AxelrodMark A Schnitzler

Abstract

Kidney transplantation with hepatitis C viremic (dHCV+) donors appears safe for recipients without HCV when accompanied by direct acting antiviral (DAA) treatment. However, US programs have been reluctant to embrace this approach due to concern about insurance coverage. While the cost of DAA treatment is currently offset by the reduction in waiting time, increased competition for dHCV+ organs may reduce this advantage. This analysis sought to demonstrate the financial benefit of dHCV+ transplant for third-party health insurers to expand coverage availability. An economic analysis was developed using a Markov model for 2 decisions: first, to accept a dHCV+ organ versus wait for a dHCV uninfected organ; or second, accept a high kidney donor profile index (KDPI) (>85) organ versus wait for a better quality dHCV+ organ. The analysis used Medicare payments, historical survival data, cost report data, and an estimated cost of DAA of $29 874. In the first analysis, using dHCV+ kidneys reduced the cost of end-stage kidney disease care if the wait for a dHCV uninfected organ exceeded 11.5 months. The financial breakeven point differed according to the cost of DAA treatment. In the second analysis, declining a high-KDPI organ in favor of...Continue Reading

References

Aug 28, 2016·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·D A AxelrodK L Lentine
May 31, 2017·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·J LevitskyM Volk
Apr 28, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·D A AxelrodK L Lentine
May 26, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Matthew KadatzJohn S Gill
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Oct 28, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Gaurav GuptaRichard K Sterling
Oct 30, 2019·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Nikhil KapilaXaralambos B Zervos
Jan 4, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·J H WangA Hart
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Feb 23, 2020·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Mark H EckmanKenneth E Sherman

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Citations

Jan 17, 2021·Clinical Journal of the American Society of Nephrology : CJASN·Su-Hsin ChangTarek Alhamad

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