Effective but costly: How to tackle difficult trade‐offs in evaluating health improving technologies in liver diseases

Barca

Giudicatti

et al. 2019

Aliment Pharmacol Ther

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Background:The World Health Organization estimated that 90% of the infected people need to be diagnosed and 80% need to be treated to reach the aim of hepatitis C virus (HCV) elimination by 2030. For this reason, all possible strategies to detect and treat HCV-infected people need to be carefully evaluated to implement the best one. Aim: To review and synthesise the economic evaluations of HCV screening programs conducted in the era of direct-acting antiviral agents regimens. Methods: A systematic literature review was conducted until April 2018 to provide information on the costs and effectiveness of HCV screenings in direct-acting antiviral agents era. A critical assessment of the quality of economic evaluations retrieved was conducted. Results: The literature search identified 716 references; 17 of them assessed cost and effectiveness of screening programs and antiviral treatments in different populations: general population (n = 7), drug users (n = 5), high-risk populations (n = 4) and other populations (n = 3). The HCV screening and direct-acting antiviral agents treatment appear to be good value for money, both in general and high-risk populations, if a cost per quality adjusted life years of $50 000 is set as willingness to pay threshold. Some studies showed the value of including lower stage of fibrosis in the treatment selection criteria.Conclusions: Several HCV screening strategies plus direct-acting antiviral agents treatments resulted cost-effectiveness in different populations. However, there is still need of country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and fully support an evidence-informed policy for HCV elimination.

Section: Discussionmentioning

confidence: 99%

Systematic review: economic evaluations of HCV screening in the direct‐acting antivirals era

Barca

Giudicatti

et al. 2019

Aliment Pharmacol Ther

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“…The WTP threshold is not a fixed parameter, but varies according to several socio-economic conditions and the policy of each specific healthcare system. 7 Thus, the results of the probabilistic sensitivity analysis were used to generate a cost-effectiveness acceptability curves (CEACs) in order to assess the probability of each treatment strategy to be economically attractive at different cost-effectiveness threshold (Figure 4). Assuming a WTP of €40 000, CEACs showed that, for patients with DCC and MELD<16, there was a 99% probability that the PRE-LT strategy was cost-effective ( Figure 4A).…”

Section: Daas Treatmentmentioning

confidence: 99%

“…5 After almost 3 years of prescribing DAAs, the best timing for treating LT candidates is still unclear. 2,[5][6][7] The aim of this study was to compare the cost-effectiveness of the aforementioned three strategies in patients with decompensated cirrhosis (DCC) or with hepatocellular carcinoma (HCC) listed for LT.…”

Section: Introductionmentioning

confidence: 99%

The optimal timing of hepatitis C therapy in liver transplant‐eligible patients: Cost‐effectiveness analysis of new opportunities

Journal of Viral Hepatitis

Belli

Facchetti

et al. 2018

Different strategies of DAAs treatment are currently possible both pre- and postliver transplantation (LT). Clinical and economic consequences of these strategies still need to be adequately investigated; this study aims at assessing their cost-effectiveness. A decision analytical model was created to simulate the progression of HCV-infected patients listed for decompensated cirrhosis (DCC) or for hepatocellular carcinoma (HCC). Three DAAs treatment strategies were compared: (i) a 12-week course of DAAs prior to transplantation (PRE-LT), (ii) a 4-week course of DAAs starting at the time of transplantation (PERI-LT) and (iii) a 12-week course of DAAs administered at disease recurrence (POST-LT). The population was substratified according to HCC presence and, in those without HCC, according to the MELD score at listing. Data on DAAs effectiveness were estimated using a cohort of patients still followed by 11 transplant centres of the European Liver and Intestine Transplant Association and by data available in the literature. In this study, PRE-LT treatment strategy was dominant for DCC patients with MELD<16 and cost-effective for those with MELD16-20, while POST-LT strategy emerged as cost-effective for DCC patients with MELD>20 and for those with HCC. Sensitivity analyses confirmed PRE-LT as the cost-effective strategy for patients with MELD≤20. In conclusion, PRE-LT treatment is cost-effective for patients with MELD≤20 without HCC, while treatments after LT are cost-effective in cirrhotic patients with MELD>20 and in those with HCC. It is worth reminding, though, that the final choice of a specific regimen at the patient level will have to be personalized based on clinical, social and transplant-related factors.

“…This is an essential information to assist decision-making processes 15, 16 and to conduct economic evaluations of health technologies as cost-utility analyses. 17 In this study we have assessed HRQoL using the EQ-5D in a large population of patients affected by CLD from various causes and at different stages and compared it with the HRQoL of a large sample of the general population. Therefore, the aim of this study was to provide a comprehensive picture of the psychosocial burden that CLDs have on patients and to help guide our approach to management.…”

Section: Introductionmentioning

confidence: 99%

Health related quality of life in chronic liver diseases

Conti

Scalone

et al. 2020

Liver International

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Background & Aims: The impact of chronic liver diseases (CLDs) on health-related quality of life (HRQoL) is relevant to understand the burden of these conditions and inform decision-making processes related to their care. Studies simultaneously comparing the HRQoL of patients affected by the major CLDs to that of the general population are still lacking and are the subject of this study. Methods: Using the EQ-5D-3L questionnaire, we analysed and compared HRQoL data from 2962 Italian patients affected by CLDs and forming a representative sample of the general Italian population (6800 individuals). Exploratory analyses were conducted to investigate the effects of each CLD on HRQoL, using the general population as reference and adjusting for possible confounders. Results: Patients with CLDs (HBV, HCV, PSC, PBC, AIH, NAFLD/NASH) in the chronic hepatitis stage and with compensated cirrhosis (CC) showed HRQoL similar to the general population. However, AIH were more likely to report problems in self-care and lower EQ-5D VAS score, while NAFLD/NASH and HCV showed an increased risk of anxiety/depression. On the other hand, with progression to more advanced | 2631 CORTESI ET al.