The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes

D A Axelrod; M A Schnitzler; T Alhamad; F Gordon; R D Bloom; G P Hess; H Xiao; M Nazzal; D L Segev; V R Dharnidharka; A S Naik; N N Lam; R Ouseph; B L Kasiske; C M Durand; K L Lentine

doi:10.1111/ajt.14895

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The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes

Journal article

Open access

Peer reviewed

The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes

D A Axelrod, M A Schnitzler, T Alhamad, F Gordon, R D Bloom, G P Hess, H Xiao, M Nazzal, D L Segev, V R Dharnidharka, …

American journal of transplantation, Vol.18(10), pp.2473-2482

10/2018

DOI: 10.1111/ajt.14895

PMCID: PMC6409105

PMID: 29701909

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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] 1.85 , P < .0001) and death (aHR 1.68 , P < .0001). Post-DAA, HCV treatment was not associated with death (aHR 0.67 , P = .25) or graft failure (aHR 0.64 , 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% ( 0.43 , P = .04) and graft loss by 46% ( 0.54 , 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.

Prognosis

Follow-Up Studies

Hepatitis C - drug therapy

Humans

Middle Aged

Male

Transplant Recipients

Young Adult

Adult

Female

Registries

Retrospective Studies

Hepacivirus - drug effects

Waiting Lists - mortality

Antiviral Agents - therapeutic use

Risk Factors

Graft Survival

Liver Transplantation - mortality

Survival Rate

Liver Transplantation - economics

Adolescent

Hepatitis C - virology

Kidney Transplantation - mortality

Aged

Kidney Transplantation - economics

Tissue Donors - supply & distribution

Details

Title: Subtitle: The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes
Creators: D A Axelrod - Lahey Hospital & Medical Center, Burlington, MA, USA
M A Schnitzler - Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
T Alhamad - Washington University, St. Louis, MO, USA
F Gordon - Lahey Hospital & Medical Center, Burlington, MA, USA
R D Bloom - University of Pennsylvania, Philadelphia, PA, USA
G P Hess - Symphony Health, Conshohocken, PA, USA
H Xiao - Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
M Nazzal - Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
D L Segev - Johns Hopkins University, Baltimore, MD, USA
V R Dharnidharka - Washington University, St. Louis, MO, USA
A S Naik - University of Michigan, Ann Arbor, MI, USA
N N Lam - University of Alberta, Edmonton, AB, Canada
R Ouseph - Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
B L Kasiske - Hennepin County Medical Center, Minneapolis, MN, USA
C M Durand - Johns Hopkins University, Baltimore, MD, USA
K L Lentine - Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.18(10), pp.2473-2482
DOI: 10.1111/ajt.14895
PMID: 29701909
PMCID: PMC6409105
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Publisher: United States
Grant note: R01DK102981 / NIDDK NIH HHS R01 DK102981 / NIDDK NIH HHS
Language: English
Date published: 10/2018
Academic Unit: Surgery
Record Identifier: 9984051705102771

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