Cost-effectiveness of transplanting lungs and kidneys from donors with potential hepatitis C exposure or infection

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作者
Nick Scott
Greg Snell
Glen Westall
David Pilcher
Michelle Raggatt
Rowan G. Walker
Margaret Hellard
Anton Y. Peleg
Joseph Doyle
机构
[1] Disease Elimination Program,Department of Epidemiology and Preventive Medicine
[2] Burnet Institute,Department of Intensive Care
[3] Monash University,Department of Medicine
[4] Lung Transplant Service,Department of Infectious Diseases, The Alfred Hospital Central Clinical School
[5] The Alfred Hospital,Infection and Immunity Theme, Monash Biomedicine Discovery Institute, Department of Microbiology
[6] The Alfred Hospital,undefined
[7] Renal Medicine,undefined
[8] The Alfred Hospital,undefined
[9] Monash University,undefined
[10] Monash University,undefined
[11] Monash University,undefined
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Scientific Reports | / 10卷
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摘要
Organ transplant guidelines in many settings recommend that people with potential hepatitis C virus (HCV) exposure or infection are deemed ineligible to donate. The recent availability of highly-effective treatments for HCV means that this may no longer be necessary. We used a mathematical model to estimate the expected difference in healthcare costs, difference in disability-adjusted life years (DALYs) and cost-effectiveness of removing HCV restrictions for lung and kidney donations in Australia. Our model suggests that allowing organ donations from people who inject drugs, people with a history of incarceration and people who are HCV antibody-positive could lead to an estimated 10% increase in organ supply, population-level improvements in health (reduction in DALYs), and on average save AU$2,399 (95%CI AU$1,155-3,352) and AU$2,611 (95%CI AU$1,835-3,869) per person requiring a lung and kidney transplant respectively. These findings are likely to hold for international settings, since this policy change remained cost saving with positive health gains regardless of HCV prevalence, HCV treatment cost and waiting list survival probabilities. This study suggests that guidelines on organ donation should be revisited in light of recent changes to clinical outcomes for people with HCV.
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