@article{ad82d4d15eb74626aa0f9f789480497b,
title = "The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes",
abstract = " Direct-acting antiviral medications (DAAs) have revolutionized care for hepatitis C positive (HCV+) liver (LT) and kidney (KT) transplant recipients. Scientific Registry of Transplant Recipients registry data were integrated with national pharmaceutical claims (2007-2016) to identify HCV treatments before January 2014 (pre-DAA) and after (post-DAA), stratified by donor (D) and recipient (R) serostatus and payer. Pre-DAA, 18% of HCV+ LT recipients were treated within 3 years and without differences by donor serostatus or payer. Post-DAA, only 6% of D-/R+ recipients, 19.8% of D+/R+ recipients with public insurance, and 11.3% with private insurance were treated within 3 years (P <.0001). LT recipients treated for HCV pre-DAA experienced higher rates of graft loss (adjusted hazard ratio [aHR] 1.34 1.85 2.10 , P <.0001) and death (aHR 1.47 1.68 1.91 , P <.0001). Post-DAA, HCV treatment was not associated with death (aHR 0.34 0.67 1.32 , P =.25) or graft failure (aHR 0.32 0.64 1.26 , P =.20) in D+R+ LT recipients. Treatment increased in D+R+ KT recipients (5.5% pre-DAA vs 12.9% post-DAA), but did not differ by payer status. DAAs reduced the risk of death after D+/R+ KT by 57% ( 0.19 0.43 0.95 , P =.04) and graft loss by 46% ( 0.27 0.54 1.07 , P =.08). HCV treatment with DAAs appears to improve HCV+ LT and KT outcomes; however, access to these medications appears limited in both LT and KT recipients.",
keywords = "clinical research/practice, economics, health services and outcomes research, infection and infectious agents – viral: hepatitis C, kidney (allograft) function/dysfunction, kidney transplantation/nephrology, liver allograft function/dysfunction, liver transplantation/hepatology, patient survival",
author = "Axelrod, {D. A.} and Schnitzler, {M. A.} and T. Alhamad and F. Gordon and Bloom, {R. D.} and Hess, {G. P.} and H. Xiao and M. Nazzal and Segev, {D. L.} and Dharnidharka, {V. R.} and Naik, {A. S.} and Lam, {N. N.} and R. Ouseph and Kasiske, {B. L.} and Durand, {C. M.} and Lentine, {K. L.}",
note = "Funding Information: This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. This work was supported by grants from the Saint Louis University Liver Center and the National Institutes of Health (NIH)/ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK102981. Funding Information: This work was conducted under the auspices of the Minneapolis Medical Research Foundation (MMRF), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. HHSH250201000018C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US Government-sponsored work, there are no restrictions on its use. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the US Government. The authors thank SRTR colleague Nan Booth, MSW, MPH, ELS, for manuscript editing. This work was supported by grants from the Saint Louis University Liver Center and the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) R01DK102981. Publisher Copyright: {\textcopyright} 2018 The American Society of Transplantation and the American Society of Transplant Surgeons",
year = "2018",
month = oct,
doi = "10.1111/ajt.14895",
language = "English (US)",
volume = "18",
pages = "2473--2482",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "10",
}