The impact of the new antiviral regimens on patient reported outcomes and health economics of patients with chronic hepatitis C

Abstract

Hepatitis C is an important cause of chronic liver disease worldwide with an estimated 170 million people infected. Hepatitis C virus (HCV)-infected patients are physically and mentally impacted by fatigue, depression and anxiety causing an impairment of health related quality of life (HRQOL), lower worker productivity and other patient reported outcomes (PROs). Although anti-HCV regimens containing first generation direct acting antiviral agents (DAAs) were associated with significant side effects, the second generation DAAs, sofosbuvir (SOF) and simeprevir (SMV), are associated with fewer side effects, better tolerability and high cure rates. Despite these advantages, key stakeholders are currently trying to find ways to best integrate these new therapeutic regimens into the management of patients with chronic hepatitis C for the benefit of all. The purpose of this article is to offer insight into the other key and equally important outcomes (PRO's, HRQOL and cost) which should be considered when assessing the applicability of these new regimens for the care of patients infected with HCV. Our review provides evidence that the new treatment regimens for HCV not only have high efficacy rates but are also associated with better patient reported outcomes and cost per case of HCV cured. Additionally, compared to other medical interventions, these new regimens are cost-effective from a societal perspective.

Hepatitis C infection: A multi-faceted systemic disease with clinical, patient reported and economic consequences

“…In summary, the current data suggest that significant PRO gains occur with the new DAA treatment regimens regardless of the patient population (coinfected, advanced fibrosis, retreatments, and treatment failures) with the largest gains noted in those patients who obtain SVR [84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101][102]. Therefore, regardless of the treatment needed, SVR should be the goal, not only to improve clinical outcomes, but also to improve patients' experience as documented by improving PRO scores.…”

“…In contrast, the use of the new interferon-and ribavirin-free all oral regimens for HCV treatment have resulted in significant improvement in patients' HRQOL scores as early as 2 weeks into the treatment, especially in those domains most affected by the hepatitis C virus [physical functioning, work productivity (presenteeism), social functioning, activity]. In fact, by the end of treatment with the DAA's many of the significantly improved scores closely approximated or surpassed the HRQOL scores of the general population without HCV [84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101]. These PRO gains have also been observed in patients with both early and advanced fibrosis [90,98].…”

“…Economic burden of work productivity loss due to HCV infection HCV infection is associated with reduced work productivity (WP) [70,[84][85]115]. HCV appears to affect absenteeism from work leading to substantial economic burden to employers.…”

“…This policy document not only emphasizes the enhancement of improved health and better access to care, but strives to improve the quality of life in the U.S. population [103]. It is also important to note that measuring PROs also provide clues about the prognosis by predicting mortality in HCV-related cirrhotics [84,102].…”

Clinical applications of squamous cell carcinoma antigen-immunoglobulins M to monitor chronic hepatitis C

“…The improvement in the antiviral efficacy of the new drug regimens promises higher cure rates with fewer side effects and shorter times of treatment compared to the old standard of care, but it is more expensive and requires major investments [55] . Although recent data have demonstrated that treatment of chronic HCV infection with one of the new oral drug regimens can reduce HCV-related complications and is cost-effective in most patients [56] , treating all eligible patients could have an enormous economic impact for both private and public resources [56] .…”