PARIS — Treating hepatitis C virus in the early stage of disease saves money in drug and medical costs while lowering risk for decompensated cirrhosis, hepatocellular carcinoma, liver transplant and liver-related death, according to a presentation at the International Liver Congress 2018.
“For all these outcomes, the best outcome is experienced by those who started treatment with mild disease, at fibrosis stage F0 and F1, and the worst by those who have advanced disease of F4 or compensated cirrhosis,” Scott Johnson, PhD, MHA, an economist with Medicus Economics LLC, said during a press conference. “The advanced patients have ten-sixteenths of the lifespan and quality of life of those who were treated when they were mild.”
Johnson explained that this modeling study was based upon Scotland’s estimated 46,657 people with HCV. Scotland restricts access to HCV treatment to those people with late-stage disease, he said. As this model is based upon Mavyret (glecaprevir/pibrentasvir, AbbVie), Johnson explained that this policy to restrict often requires longer treatment of 12 weeks vs. 8 weeks if treating early-stage disease.
Lifetime risk for decompensated cirrhosis when treated at F0/F1 was 4%, as compared to 11.6% when treated at F4 or compensated cirrhosis. Lifetime risk for HCC when treated at F0/F1 was 1.8% vs. 35.2% when treated at F4 or compensated cirrhosis. Lifetime risk for liver transplant was 0.4% at F0/F1 vs. 2.6% at F4/compensated cirrhosis. Lastly, lifetime risk for liver-related death was 3.8% at F0/F1 vs. 41.1% at F4/compensated cirrhosis.
Johnson showed that although overall sustained virologic response rates were very similar, lifetime quality-associated life-years decreased as initial disease level increased. Patients treated for HCV when still at F0/F1 gained 16.2 lifetime QALYs. If patients reached F2/F3 before treatment, they gained 13.9 QALYs. If patients did not receive HCV treatment until F4 or compensated cirrhosis, they gained 10 QALYs.
“The cost of treating the F4/CC patient ... is much higher. It’s almost twice what it is to treat the mild patient. The payer is actually paying more to treat these advanced patients,” Johnson said. “That’s because there’s a greater disease burden ... but also because you’re treating them with a longer regimen.”
Direct medical costs also nearly doubled when treatment is withheld until late-stage disease, Johnson showed. If treated at F0/F1, costs are estimated to be £32,996; at F4 or compensated cirrhosis, costs are estimated to be £60,963. Johnson said about £40,000 of the total health care costs are drug costs.
“Even just based on drug treatment cost alone, it makes more sense to treat the earlier stage patient,” Johnson said.
“This study shows the impact that delayed treatment can have on a patient’s life, including consequences such as liver morbidity and mortality, as well as extrahepatic complications,” Sammy Saab, MD, professor of medicine and surgery at the University of California, Los Angeles, said in a press release. “Beyond benefits to the patients, early treatment can generate significant savings by reducing clinical risks and allowing for a shorter, 8-week duration of treatment across all genotypes.” - by Katrina Altersitz
For more information:
Pinsky B, et al. PS-058. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.
Disclosure: This study was supported by AbbVie. Medicus Economics, LLC received consulting fees for research from AbbVie. Saab reports being a consultant to and serves on speaker bureaus for AbbVie Inc., Bristol-Myers Squibb, Gilead, Janssen and Merck.
Editor’s note: This item has been updated with clarifications from the presenter.