Cost-effectiveness of hepatitis C-positive donor kidney transplantation for hepatitis C-negative recipients with concomitant direct-acting antiviral therapy

Am J Transplant. 2018 Oct;18(10):2496-2505. doi: 10.1111/ajt.15054. Epub 2018 Aug 30.


Pilot studies suggest that transplanting hepatitis C virus (HCV)-positive donor (D+) kidneys into HCV-negative renal transplant (RT) recipients (R-), then treating HCV with direct-acting antivirals (DAA) is clinically feasible. To determine whether this is a cost-effective approach, a decision tree model was developed to analyze costs and effectiveness over a 5-year time frame between 2 choices: RT using a D+/R- strategy compared to continuing dialysis and waiting for a HCV-negative donor (D-/R-). The strategy of accepting a HCV+ organ then treating HCV was slightly more effective and substantially less expensive and resulted in an expected 4.8 years of life (YOL) with a cost of ≈$138 000 compared to an expected 4.7 YOL with a cost of ≈$329 000 for the D-/R- strategy. The D+/R- strategy remained dominant after sensitivity analyses including the difference in RT death probabilities or acute rejection probabilities between using D+ vs D- kidney; time that D-/R- patients waited for RT; dialysis death probabilities while waitlisted for RT in the D-/R- strategy; DAA therapy expected cure rate; costs of transplant, immunosuppressives, DAA therapy, dialysis, or acute rejection. The D+/R- strategy followed by treatment with DAA is less costly and slightly more effective compared to the D-/R- strategy.

Keywords: business/management; clinical decision-making; dialysis; donors and donation: deceased; ethics and public policy; health services and outcomes research; infection and infectious agents - viral: hepatitis C; infectious disease; kidney transplantation/nephrology; quality of life (QOL).

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Cost-Benefit Analysis*
  • Follow-Up Studies
  • Graft Survival*
  • Hepacivirus / drug effects
  • Hepatitis C / drug therapy*
  • Hepatitis C / virology
  • Humans
  • Kidney Failure, Chronic / economics*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation / economics*
  • Kidney Transplantation / mortality
  • Models, Statistical
  • Prognosis
  • Risk Factors
  • Survival Rate
  • Tissue Donors / supply & distribution
  • Transplant Recipients
  • Waiting Lists / mortality*


  • Antiviral Agents