A prophylaxis strategy for hepatitis C virus (HCV) infected kidney donors for uninfected reciepents could be both effective and cost effective.¹

A team, led by Jessica S. Jay, PharmD, Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, reported on a cost minimization analysis using the health system perspective to determine the least expensive DAA regimen using available published strategies.

Trials

Often trials that focus on 4-12 week courses of DAAs to treat HCV transmission from infected donors to uninfected kidney transplant recipients are limited in application due to costs and delayed access to the costly treatments.

However, a short prophylactic strategy could be both safer and cost-effective.

In the study, the investigators conducted a cost-minimization analyses from the health system perspective of 4 DAA regimens to prevent and/or treat HCV transmission from infected donors to uninfected kidney transplant recipients.

The Study

The team compared a 7-day prophylaxis with generic sofosbuvir/velpatasvir (SOF/VEL), with 12 week branded glecaprevir/pibrentasvir (G/P) for those with transmission, 8-day branded G/P prophylaxis, with 12-week branded sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for those with transmission, 4-week peri-operative generic SOF/VEL prophylaxis, with 12-week branded G/P for those with transmission, or an 8-week branded G/P ‘transmit-and-treat.’

The investigators estimated the probability of viral transmission in patients who received DAA prophylaxis and a summed a 100% transmission rate for those who received the ‘transmit-and-treat’ approach using data from published literature.

The expected cost of the first strategy was $2,326 and $2,646 in the second strategy, compared to $4,859 for the third strategy and $18,525 for the fourth strategy.

However, after conducting a threshold analysesfor the 7-day SOF/VEL compared to the 8-day G/P, the investigators found there were reasonable input levels where the 8-day strategy could actually be the least costly.

In addition, the threshold values for the SOF/VEL prophylaxis strategies showed that the 4-week strategy likely won’t be less costly under any reasonable value of the input variables.

“Short duration DAA prophylaxis using 7 days of SOF/VEL or 8 days of G/P has the potential to yield significant cost savings for D+/R- transplants,” the authors wrote.

The Value of DAA

Access to direct-acting antivirals (DAA) for patients with chronic HCV helps improve outcomes, according to a 2022 study.²

In the Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C), the investigators examined data from a national observational cohort of 96 clinical services, including specialist clinics and less traditional settings, including general practices.

Various factors decreased the likelihood of achieving SVR, including male gender (aOR, 0.56; 95% CI, 0.43-0.72), cirrhosis (aOR, 0.52; 95% CI, 0.41-0.64), recent injecting drug use (aOR, 0.64; 95% CI, 0.46-0.91), and previous DAA treatment (aOR, 0.50; 95% CI, 0.28-0.90).

However, other factors modified the loss to follow-up, including IDU ± opioid agonist therapy (OAT; IDU only: aOR, 1.75; 95% CI, 1.44-2.11; IDU + OAT: aOR, 1.39; 95% CI, 1.11-1.74; OAT only, aOR, 1.36; 95% CI, 1.13-1.68) and age (aOR, 0.97; 95% CI 0.97-0.98).

References:

1. Jay, J. S., Patterson, J. A., Zhang, Y., Ijioma, S. C., Carroll, N. V., Holdford, D. A., Sterling, R. K., Gupta, G., & Yakubu, I. (2023). Cost minimization analysis of short-duration anti-viral prophylaxis for hepatitis C positive donor kidney transplants. Journal of the American Pharmacists Association. https://doi.org/10.1016/j.japh.2023.06.027

2. Walter, K. (2021, November 8). Access to direct-acting antivirals improves outcomes for hepatitis C patients. HCP Live. https://www.hcplive.com/view/access-direct-acting-antivirals-outcomes-hepatitis-c-patients