Impact of All‐Oral Direct‐Acting Antivirals on Clinical and Economic Outcomes in Patients With Chronic Hepatitis C in the United States

Abstract

Approved treatment for hepatitis C virus (HCV) with all-oral direct acting antivirals (DAA) therapy is now entering into its fourth year; however, little has been reported on the real world clinical [decompensated cirrhosis (DCC) and hepatocellular carcinoma (HCC)] and economic outcomes. A retrospective cohort analysis of the Truven Health MarketScan Database (2012 - 2016) was conducted. In a cohort of 26,105 newly diagnosed HCV patients, 30% received all-oral DAA therapy (DAA group) and 70% were not treated (untreated group). Multivariate Cox proportional hazards models were used to compare the risk of developing HCC and DCC, stratified by cirrhosis status. Among cirrhotic patients (n=2,157), DAA therapy was associated with a 72% and a 62% lower incidence of HCC (hazard ratio (HR): 0.28; 95% confidence interval (CI):0.15-0.52) and DCC (HR: 0.38; 95% CI: 0.26-0.56). Similarly, DAA therapy was associated with a 57% and a 58% lower incidence of HCC (HR: 0.43; 95% CI:0.26-0.71) and DCC (HR: 0.42; 95% CI: 0.30-0.58) in non-cirrhotic HCV patients (n=23,948). A propensity-score matched cohort of 8,064 HCV-infected patients who had at least a 12-month follow-up after HCV treatment was included for economic analysis. For cirrhotic patients in the DAA group, the mean adjusted liver-related costs ($1,749 vs $4,575; P<0.001) and all-cause medical costs ($19,300 vs $33,039; P<0.001) were significantly lower compared to those in the untreated group. The mean adjusted costs were not statistically different between the two groups among non-cirrhotic patients. Conclusions: In the short term, all-oral DAA treatment for HCV infection was associated with a decreased risk of developing HCC and DCC resulting in decreased healthcare costs, especially in cirrhotic patients. A longitudinal study is necessary to confirm our findings.

HCV-Infected Individuals have Higher Prevalence of Comorbidity and Multimorbidity: A retrospective cohort study

“…In addition to well-known reductions in mortality and liver-specific comorbidity, HCV treatment has also been shown to reduce future comorbidity, including diabetes, renal disease, cardiovascular disease, mental and cognitive health, and quality of life. [67][68][69][70][71][72][73] As such, our findings support current calls for taking a broad, inclusive approach to offering HCV antiviral therapy regardless of physical and mental health comorbidity and mode of HCV transmission, including injection drug use. With the evidence that the management of chronic diseases is most effectively and economically provided in well-supported primary care settings [74,75], our findings call for integrated, comprehensive, community-oriented approaches to HCV care delivery.…”

HCV-infected individuals have higher prevalence of comorbidity and multimorbidity: a retrospective cohort study

“…Middle-aged individuals with substance use disorder were less likely to receive treatment, even in the DAA era. In addition to well-known reductions in mortality and liver-specific comorbidity, HCV treatment has also been shown to reduce future comorbidity, including diabetes, renal disease, cardiovascular disease, mental and cognitive health, and quality of life [67][68][69][70][71][72][73]. As such, our findings support current calls for taking a broad, inclusive approach to offering HCV antiviral therapy regardless of physical and mental health comorbidity and mode of HCV transmission, including injection drug use.…”

Impact of hepatitis C virus treatment on the risk of non‐hepatic cancers among hepatitis C virus‐infected patients in the US

“…20,[26][27][28][29][30][31][32][33][34][35][36] Medications with preventative or hazardous effects on cancer were identified using the National Drug Codes (NDC) and the unique therapy class in the database (Table S4), including statin, proton pump inhibitor (PPI) and hormone therapies. 10,27 Among all HCV-infected patients, to adjust the potential impact of different healthcare utilisation behaviour on the cancer outcome identification, we also identified the mean number of in-patient visits and out-patient office visits in the 12 months prior to the index date.…”

“…[4][5][6][7][8][9] The impact of HCV treatment on the reduced risk of liver complications among HCV-infected patients has been well studied. [10][11][12] Furthermore, recent studies suggest that anti-viral therapy for chronic HCV can reduce the risk of developing extrahepatic manifestations, such as chronic kidney disease (CKD) and cardiovascular disease. 9,13,14 HCV treatment may mitigate the risk of both liver disease and extrahepatic manifestations by viral clearance and reductions in hepatic and systemic inflammation.…”