Skip to main content

Advertisement

SpringerLink
Log in

Cost-Effectiveness of Utilization of Hepatitis B Virus-Positive Liver Donors for HBV-Negative Transplant Recipients

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Utilization of hepatitis B virus (HBV)-infected donors represents an opportunity to expand the liver transplantation (LT) donor pool. However, benefits of accepting HBV-positive donors for HBV-negative candidates, potentially expanding the donor pool resulting in earlier transplantation, must be balanced with costs of lifelong antiviral therapy. The aim of this study was to evaluate cost-effectiveness of this strategy.

Methods

We developed a Markov model with two strategies, transplant with (1) a HBV-positive donor versus and (2) a HBV-negative donor for a HBV-negative LT candidate. A healthcare system perspective was utilized, effectiveness measured in quality-adjusted life-years, and costs in 2018 USD.

Results

In the base-case, the HBV-positive donor strategy is more effective (gain of 0.46 QALYs), but $26,159 more expensive, yielding an incremental cost-effectiveness ratio (ICER) of $57,389/QALY. However, increasing the candidate’s Model for End-Stage Liver Disease score resulted in increasing cost-effectiveness, ICER of $69,507/QALY (MELD 6–10) to $47,385/QALY (MELD > 30). Results were most sensitive to antiviral cost and cost after first year of LT. In probabilistic sensitivity analysis, the HBV-positive strategy was always more effective but more expensive, with average ICER of $64,883/QALY. This strategy was highly cost-effective (ICER < $50,000/QALY) 21% of the time and cost < $100/000/QALY 94% of the time.

Conclusions

Consideration of these donors must be individualized to each candidate’s severity of liver disease, associated costs, and personal preferences that impact quality of life. Expansion of the donor pool to include HBV-positive donors for appropriate recipients may be a cost-effective policy and may provide significant benefit for individual patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Huprikar S, Danziger-Isakov L, Ahn J, et al. Solid organ transplantation from hepatitis B virus-positive donors: consensus guidelines for recipient management. Am J Transplant. 2015;15(5):1162-1172.

    Article  CAS  Google Scholar 

  2. Cholongitas E, Papatheodoridis GV, Burroughs AK. Liver grafts from anti-hepatitis B core positive donors: a systematic review. J Hepatol. 2010;52(2):272-279.

    Article  CAS  Google Scholar 

  3. MacConmara MP, Vachharajani N, Wellen JR, et al. Utilization of hepatitis B core antibody-positive donor liver grafts. HPB (Oxford). 2012;14(1):42-48.

    Article  Google Scholar 

  4. Bohorquez HE, Cohen AJ, Girgrah N, et al. Liver transplantation in hepatitis B core-negative recipients using livers from hepatitis B core-positive donors: a 13-year experience. Liver Transpl. 2013;19(6):611-618.

    Article  Google Scholar 

  5. Loggi E, Conti F, Cucchetti A, Ercolani G, Pinna AD, Andreone P. Liver grafts from hepatitis B surface antigen-positive donors: A review of the literature. World J Gastroenterol. 2016;22(35):8010-8016.

    Article  Google Scholar 

  6. Li Z, Hu Z, Xiang J, et al. Use of hepatitis B surface antigen-positive grafts in liver transplantation: a matched analysis of the US National database. Liver Transpl. 2014;20(1):35-45.

    Article  CAS  Google Scholar 

  7. Loggi E, Micco L, Ercolani G, et al. Liver transplantation from hepatitis B surface antigen positive donors: a safe way to expand the donor pool. J Hepatol. 2012;56(3):579-585.

    Article  Google Scholar 

  8. Saidi RF, Jabbour N, Shah SA, Li YF, Bozorgzadeh A. Liver transplantation from hepatitis B surface antigen-positive donors. Transplant Proc. 2013;45(1):279-280.

    Article  CAS  Google Scholar 

  9. Yu S, Yu J, Zhang W, et al. Safe use of liver grafts from hepatitis B surface antigen positive donors in liver transplantation. J Hepatol. 2014;61(4):809-815.

    Article  CAS  Google Scholar 

  10. Jeng LB, Thorat A, Yang HR, et al. Successful use of hepatitis B surface antigen-positive liver grafts - an effective source for donor organs in endemic areas: a single-center experience. Ann Transplant. 2015;20:103-111.

    Article  CAS  Google Scholar 

  11. Ju W, Chen M, Guo Z, et al. Allografts positive for hepatitis B surface antigen in liver transplant for disease related to hepatitis B virus. Exp Clin Transplant. 2013;11(3):245-249.

    Article  Google Scholar 

  12. Theodoropoulos N, Nowicki MJ, Chinchilla-Reyes C, et al. Deceased organ donor screening for human immunodeficiency virus, hepatitis B virus and hepatitis C virus: Discordant serology and nucleic acid testing results. Transpl Infect Dis. 2018;20(1).

  13. Theodoropoulos N, Jaramillo A, Ladner DP, Ison MG. Deceased organ donor screening for HIV, hepatitis B, and hepatitis C viruses: a survey of organ procurement organization practices. Am J Transplant. 2013;13(8):2186-2190.

    Article  CAS  Google Scholar 

  14. Lee TC, Kaiser TE, Luckett K, et al. Use, Safety, and Effectiveness of Viremic Hepatitis B Virus Donor Livers: A Potential Opportunity to Expand the Donor Pool. Liver Transpl. 2019;25(10):1581-1584.

    Article  Google Scholar 

  15. Saab S, Kardashian A, Saggi S, Choi G, Agopian V, Tong MJ. Use of hepatitis C-positive grafts in hepatitis C-negative liver transplant recipients is cost effective. Clin Transplant. 2018;32(10):e13383.

    Article  Google Scholar 

  16. Bethea ED, Samur S, Kanwal F, et al. Cost Effectiveness of Transplanting HCV-Infected Livers Into Uninfected Recipients With Preemptive Antiviral Therapy. Clin Gastroenterol Hepatol. 2019;17(4):739-747 e738.

    Article  Google Scholar 

  17. United Network for Organ Sharing Standard Transplant Analysis and Research Files, as of March 31, 2019. 2019.

  18. Perkins JD, Halldorson JB, Bakthavatsalam R, Fix OK, Carithers RL, Jr., Reyes JD. Should liver transplantation in patients with model for end-stage liver disease scores <or= 14 be avoided? A decision analysis approach. Liver Transpl. 2009;15(2):242-254.

    Article  Google Scholar 

  19. Chhatwal J, Kanwal F, Roberts MS, Dunn MA. Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States. Ann Intern Med. 2015;162(6):397-406.

    Article  Google Scholar 

  20. Office of Procurement AaL. VA Federal Supply Schedule Pharmaceutical Prices. 2019.

  21. Centers for Medicare & Medicaid Services Clinical Laboratory Fee Schedule Files. 2019.

  22. Woo G, Tomlinson G, Yim C, et al. Health state utilities and quality of life in patients with hepatitis B. Can J Gastroenterol. 2012;26(7):445-451.

    Article  Google Scholar 

  23. Russell RT, Feurer ID, Wisawatapnimit P, Pinson CW. The validity of EQ-5D US preference weights in liver transplant candidates and recipients. Liver Transpl. 2009;15(1):88-95.

    Article  Google Scholar 

  24. United Network for Organ Sharing Standard Transplant Analysis and Research Files, as of June 30, 2018. 2018.

  25. Chang TT, Gish RG, de Man R, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med. 2006;354(10):1001-1010.

    Article  CAS  Google Scholar 

  26. Lai CL, Shouval D, Lok AS, et al. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. N Engl J Med. 2006;354(10):1011-1020.

    Article  CAS  Google Scholar 

  27. Colonno RJ, Rose R, Baldick CJ, et al. Entecavir resistance is rare in nucleoside naive patients with hepatitis B. Hepatology. 2006;44(6):1656-1665.

    Article  CAS  Google Scholar 

  28. Wu B, Li T, Chen H, Shen J. Cost-effectiveness of nucleoside analog therapy for hepatitis B in China: a Markov analysis. Value Health. 2010;13(5):592-600.

    Article  Google Scholar 

  29. Fung J, Wong T, Chok K, et al. Long-term outcomes of entecavir monotherapy for chronic hepatitis B after liver transplantation: Results up to 8 years. Hepatology. 2017;66(4):1036-1044.

    Article  CAS  Google Scholar 

  30. Ratcliffe J, Longworth L, Young T, et al. Assessing health-related quality of life pre- and post-liver transplantation: a prospective multicenter study. Liver Transpl. 2002;8(3):263-270.

    Article  Google Scholar 

  31. McLernon DJ, Dillon J, Donnan PT. Health-state utilities in liver disease: a systematic review. Med Decis Making. 2008;28(4):582-592.

    Article  Google Scholar 

  32. Axelrod DA. Economic and financial outcomes in transplantation: whose dime is it anyway? Curr Opin Organ Transplant. 2013;18(2):222-228.

    Article  Google Scholar 

  33. Axelrod DA, Gheorghian A, Schnitzler MA, et al. The economic implications of broader sharing of liver allografts. Am J Transplant. 2011;11(4):798-807.

    Article  CAS  Google Scholar 

  34. Viral Hepatitis: Commentary. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/statistics/2016surveillance/commentary.htm. Accessed May 27, 2020.

  35. Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis infections from nationally reported cases. Am J Public Health. 2014;104(3):482-487.

    Article  Google Scholar 

Download references

Funding

Funding for this study was provided by the University of Cincinnati Department of Surgery.

Author information

Authors and Affiliations

  1. Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Cincinnati, OH, USA

    Tiffany C. Lee & Shimul A. Shah

  2. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Tiffany C. Lee & Shimul A. Shah

  3. Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Mark H. Eckman

  4. Division of Transplantation, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, MSB 2006C, Cincinnati, OH, 45267-0558, USA

    Shimul A. Shah

Authors
  1. Tiffany C. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark H. Eckman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shimul A. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TCL, MHE, and SAS: Substantial contributions to the conception or design of the work; acquisition, analysis, or interpretation of the data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Shimul A. Shah.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

ESM 1

(DOCX 44 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, T.C., Eckman, M.H. & Shah, S.A. Cost-Effectiveness of Utilization of Hepatitis B Virus-Positive Liver Donors for HBV-Negative Transplant Recipients. J Gastrointest Surg 25, 1760–1769 (2021). https://doi.org/10.1007/s11605-020-04759-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-020-04759-4

Keywords

Search

Navigation