Cost-effectiveness of using hepatitis C viremic hearts for transplantation into HCV-negative recipients

Cathy Logan, Ily Yumul, Javier Cepeda, Victor Pretorius, Eric Adler, Saima Aslam, Natasha K. Martin

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Outcomes following hepatitis C virus (HCV)-viremic heart transplantation into HCV-negative recipients with HCV treatment are good. We assessed cost-effectiveness between cohorts of transplant recipients willing and unwilling to receive HCV-viremic hearts. Markov model simulated long-term outcomes among HCV-negative patients on the transplant waitlist. We compared costs (2018 USD) and health outcomes (quality-adjusted life-years, QALYs) between cohorts willing to accept any heart and those willing to accept only HCV-negative hearts. We assumed 4.9% HCV-viremic donor prevalence. Patients receiving HCV-viremic hearts were treated, assuming $39 600/treatment with 95% cure. Incremental cost-effectiveness ratios (ICERs) were compared to a $100 000/QALY gained willingness-to-pay threshold. Sensitivity analyses included stratification by blood type or region and potential negative consequences of receipt of HCV-viremic hearts. Compared to accepting only HCV-negative hearts, accepting any heart gained 0.14 life-years and 0.11 QALYs, while increasing costs by $9418/patient. Accepting any heart was cost effective (ICER $85 602/QALY gained). Results were robust to all transplant regions and blood types, except type AB. Accepting any heart remained cost effective provided posttransplant mortality and costs among those receiving HCV-viremic hearts were not >7% higher compared to HCV-negative hearts. Willingness to accept HCV-viremic hearts for transplantation into HCV-negative recipients is cost effective and improves clinical outcomes.

Original languageEnglish (US)
Pages (from-to)657-668
Number of pages12
JournalAmerican Journal of Transplantation
Issue number2
StatePublished - Feb 2021
Externally publishedYes


  • clinical research/practice
  • economics
  • health services and outcomes research
  • heart transplantation/cardiology
  • infection and infectious agents – viral: hepatitis C
  • infectious disease
  • mathematical model
  • organ acceptance
  • organ procurement and allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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