An Economic Analysis of Transplanting Hepatitis C Positive Hearts in Uninfected Recipients Open Access

Abstract

Heart transplants are the most effective approach to treating the growing population suffering from heart failure. However, presently the demand for hearts far outpaces the supply. The previously chronic and incurable Hepatitis C (HCV) infection is now curable in a 12-week, highly-effective, and well-tolerated dose of direct-acting antivirals (DAA). Using HCV-infected hearts in uninfected patients represents an enormous potential to expand the donor pool. In the past 20 years, the prevalence of HCV positive organ donors has increased tremendously. This is in part due to unsafe practices such as needle sharing in populations at risk to overdosing as a result of the opioid epidemic. These individuals tend to be younger, healthier, and donate organs of higher quality compared to the general pool. Yet, only a small fraction of HCV positive organs is used for transplantation. Using a fixed-effects regression analysis which controlled for center-related variations, clinical factors, and changes over time, this study found multiple significant positive externalities at the hospital level in adopting the HCV strategy. By adopting the HCV strategy, the highest priority patients experience an 18.614-day reduction in wait days compared to the current 37.246 average days. This significant reduction in wait time is associated with better outcomes and reduced costs. Hospitals perform 1.849 more transplants per quarter and can more effectively serve the aging population. Heart failure is a major economic burden on the United States and using the currently wasted potential of HCV hearts has the potential to alleviate a major inefficiency in the organ market.

Table of Contents

Background and Motivation 1

Introduction 2

Related Literature 4

Data 7

Methodology 11

Results 16

Discussion 17

Conclusion 24

References 26

About this Honors Thesis

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School	Emory College
Department	Economics
Degree	B.A.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery Economics, General Health Sciences, Health Care Management
Keyword	heart transplant heart transplant heart failure DAA HCV direct-acting antiviral hepatitis
Committee Chair / Thesis Advisor	Ian McCarthy, Emory University
Committee Members	C. Michael Hart, Emory University Evan Saltzman, Emory University David Howard, Emory University

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