The American Journal of Managed Care Special Issue: HCV
The Wider Public Health Value of HCV Treatment Accrued by Liver Transplant Recipients
Objectives: Organs for transplantation are scarce, but new medical therapies can prevent organ failure and the need for transplants. We sought to describe the unique value created by treatments that spare organs from failure and thus conserve donated organs for transplant into others, using hepatitis C virus (HCV) as a case study.
Study Design: Epidemiologic-economic model.
Methods: Using data on trends in chronic liver disease, liver disease progression, and liver transplant allocation models, as well as the effectiveness of new HCV treatments, we estimate the potential effects of systematic HCV screening and treatment on the demand for liver transplants in the United States. We estimate the spillover benefits to patients with all-cause liver disease in terms of increased availability of transplants and life-years gained.
Results: We estimated that systematic HCV screening and treatment could spare 10,490 liver transplants to HCV-infected patients from 2015 to 2035. An estimated 7321 transplants would accrue to patients with end-stage liver disease without HCV and 3169 transplants to those with uncured HCV, providing approximately 52,700 and 22,800 additional life-years, respectively.
Conclusions: Treatment advances for HCV have the potential to generate considerable spillover benefits to patients awaiting transplants for non–HCV-mediated liver failure. For other diseases in which organ transplants are in short supply, our study provides a novel pathway by which positive spillovers may accrue from treatments that prevent end-stage organ disease.
Am J Manag Care. 2016;22(5 Spec Issue No. 6):SP212-SP219
- Organs for transplantation are scarce, but innovative hepatitis C virus (HCV) therapies can prevent liver failure and the need for transplants.
- Systematic HCV screening and treatment would spare 10,490 livers for transplant over 20 years, with almost 70% of these livers benefitting patients with non–HCV-mediated liver failure.
- The increased availability of donor livers will lead to 52,700 additional life-years for patients without HCV infection and 22,800 life-years for patients with HCV, providing economic values of $7.9 billion and $3.5 billion, respectively.
- Such spillover benefits to untreated populations underscore the value of innovative therapies in preventing organ failure.
The availability of organs for transplantation is scarce. In the United States alone, more than 7000 individuals die awaiting organ transplantation each year.3 In this study, we explored this idea by applying it to recently introduced therapies for hepatitis C virus (HCV) infection. An estimated 3 million individuals in the United States are affected by chronic HCV, a condition associated with long-term injury to the liver and with complications including cirrhosis, hepatocellular carcinoma, and, ultimately, liver failure (see eAppendix, available at www.ajmc.com, for further details).4,5 The most common reason for liver transplantation in the United States is end-stage liver disease (ESLD), and currently, nearly 50% (14,000/29,000) of ESLD cases among transplant recipients are due to HCV.3
Until recently, treatments for HCV were neither particularly effective nor well tolerated.6 However, newer HCV therapies suppress the virus in more than 90% of patients, making an effective cure of HCV highly likely for the majority of those affected.7-9 Curing patients of HCV obviates their need for future liver transplantation due to HCV, thus creating opportunities for transplantation into patients with other forms of ESLD.
Currently, only one-third of Americans who need liver transplants receive them,10 and shortages are expected to rise as the transplant waiting list continues to grow while the supply of organs remains flat.11 Obesity and the aging of the population are reducing the quality of deceased donor livers, while obesity-related liver disease is also increasing the demand for them.12
We simulated the effect of a systematic HCV screening and treatment program in the United States on the number of livers spared from transplantation into patients with HCV-mediated ESLD. We estimated the number of these spared livers that could be transplanted into patients with other forms of ESLD, as well as the resulting benefits to both groups. Our analysis takes a broader perspective than do existing models of HCV burden5,13-17 because it recognizes that treatment of patients with HCV creates positive spillovers for non-HCV patients with ESLD.
Our study relied on 2 main data sources: first, the National Health and Nutrition Examination Survey (NHANES), a biennial survey administered to a nationally representative sample of the US population. Along with a survey of health and healthcare utilization, participants also give blood samples and undergo other diagnostic tests. This data set was used to generate trends over time in liver disease and in key risk factors. Our second data source was the United Network for Organ Sharing (UNOS) database, which holds information on every patient on the waiting list for organ transplantation in the United States since 1987, including patient characteristics, primary disease, source of organ, and time spent on waiting list.