Disclosures: Kalidindi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
July 21, 2020
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DAAs lower risk for death among patients with HCV, regardless of cirrhosis

Disclosures: Kalidindi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Treatment with direct-acting antivirals was associated with decreased mortality among a sample of more than 50,000 Medicare beneficiaries with hepatitis C virus, regardless of the presence of cirrhosis, according to data published in JAMA Network Open.

Yamini Kalidindi, MHA, an associate at the Moran Company, and colleagues noted that HCV is the most common bloodborne illness in the United States, and that evidence of the cost-effectiveness of DAA treatment is lacking.

“Previous simulations used extended lives as a key outcome to indicate that the benefits associated with DAA treatment can exceed the costs of these drugs,” they wrote. “However, real-world evidence is limited on the association between DAA treatment and reduced mortality, information that is crucial to assessing the value of costly DAA drugs.”

To examine the association of DAA treatment with mortality among Medicare beneficiaries with HCV, Kalidindi and colleagues performed a cohort study using the claims data of 51,478 Medicare beneficiaries who sought HCV care for the first time between Jan. 1, 2014, and Dec. 31, 2016, after at least a 1-year “washout period.” They obtained death dates, demographic data and indicators of health risks from the Master Beneficiary Summary Files.

Overall, the study showed that DAA treatment was statistically significantly associated with a decrease in mortality among patients with and without cirrhosis.

According to the study, 8,240 patients (16%) had cirrhosis and 43,238 patients (84%) did not.

In the cirrhosis arm, the adjusted HR of dying between patients treated with DAAs and those not treated with DAAs was 0.51 (95% CI, 0.46-0.57). The study showed that the association of DAA treatment with mortality did not differ by sex or dual-eligibility status in the cirrhosis group.

The study showed that, among patients without cirrhosis, the adjusted HR of dying between those receiving DAA treatment and those without DAA treatment was 0.54 (95% CI, 0.50-0.58). Similar to the first group, these data did not differ by sex. However, the researchers found that the survival advantage associated with DAAs for nondual-eligible beneficiaries was statistically significantly higher than that for dual-eligible beneficiaries among patients without cirrhosis (HR = 0.47; 95% CI, 0.41-0.55 vs. HR = 0.57; 95% CI,0.52-0.62).

“These findings suggest that increasing access to direct-acting antiviral drugs for all patients with hepatitis C virus infection, regardless of disease progression, could improve population health,” the authors concluded.