Fewer HCC cases from HCV clearance improves quality of life, cost savings
WASHINGTON — Through treatment of hepatitis C genotype 1 with direct-acting antivirals, significant direct and indirect cost savings may arise due to fewer cases of hepatocellular carcinoma and decompensated cirrhosis, according to results of a simulated model presented at The Liver Meeting 2017.
“As you know, chronic hepatitis C is a systemic infection that’s associated with adverse clinical outcomes, both hepatic as well as extrahepatic,” Zobair M. Younossi, MD, MPH, chairman of the department of medicine at Inova Fairfax Hospital and vice president for research at Inova Health System in Falls Church, Virginia, said in his presentation. “There is a significant burden associated hepatic infection and there’s also a number of, as studies have shown, that hepatitis C impairs patient-reported outcome such as health-related quality of life.
According to Younossi, there is significant data to suggest that sustained virologic response is associated with improvement in patient-reported outcomes, including quality of life, fatigue and work productivity. “However,” he said, “most of the studies have relatively short follow-up, so the sustainability of this improvement and quality of life ... have not been established.”
To estimate the economic and quality of life benefits of successful HCV treatment, the researchers created a hypothetical cohort of 10,000 Japanese patients aged 60 years with HCV genotype 1.
The model was designed to capture the natural history of HCV over a lifetime horizon and included data on treatment efficacy of DAAs from randomized control trials and transition rates and costs from Japanese databases. In the simulated cohort, 15% portion had cirrhosis and 20% were treatment-experienced.
DAA treatment led to 2,078 fewer cases of HCC and 1,495 fewer cases of decompensated cirrhosis compared with patients who did not receive treatment. Avoidance of HCC and decompensated cirrhosis saved 857,946 yen and 341,645 yen per treated patient, respectively.
Additionally, the researchers found that DAA treatment led to 2.67 more quality-adjusted life years per patient. This correlated with an indirect economic gain of 10,680,000 yen, 13,350,000 yen and 16,020,000 yen per patient at willing-to-pay thresholds of 4 million yen, 5 million yen and 6 million yen.
In conclusion,” Younossi said, “improvement of quality of life after SVR is maintained in the long-run. These data support the comprehensive benefit and the sustainability of this benefit from treating hepatitis C that should have important policy implications for countries that are trying to eradicate hepatitis C. It is not only about clinical benefit but also patient experience benefit.” – by Talitha Bennett
Younossi ZM, et al. Abstract 22. Presented at: The Liver Meeting; Oct. 20-24, 2017; Washington, D.C.
Disclosure: Younossi reports no relevant financial disclosures.