Timing of hepatitis C antiviral therapy in patients with advanced liver disease: A decision analysis model

Saab, Sammy; Hunt, Douglas; Stone, Michael A.; McClune, Amy; Tong, Myron J.

doi:10.1002/lt.22072

Cited by 55 publications

(54 citation statements)

References 84 publications

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“…A recent study attempted to determine the most cost effective timing for AVT (PEG IFN and ribavirin) in advanced liver disease infected with HCV genotype 1 and concluded that treatment of patients with compensated cirrhosis was the most cost effective [117] . Four different treatment strategies in a hypothetical cohort of 4000, 55 years old, treatment naïve cirrhotics with a 17 year follow-up, were analyzed in a Markov model.…”

Section: Post-transplant Antiviral Treatmentmentioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

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Section: Post-transplant Antiviral Treatmentmentioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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“…Prior to our analysis, cost-effectiveness of HCV treatment post OLT has only been studied by Saab et al in a North American cohort of patients [42,43]. In his first study [42], antiviral treatment with an estimated SVR of 20% resulted in a gain of 0.41 life-years compared with no treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Aim of another CEA of Saab et al [43] was to determine the best time point for Peg-IFN/RBV treatment in cirrhotic patients. Clinical and economic outcome of antiviral treatment of patients with compensated cirrhosis versus DC versus post OLT was assessed.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of antiviral treatment in liver transplant recipients with HCV infection

et al. 2013

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SummaryWithin 5-10 years, 20-40% of hepatitis C virus (HCV)-infected liver transplant recipients can be expected to develop cirrhosis. Here, cost-effectiveness of antiviral therapy was assessed. A Markov model was developed to simulate disease progression and calculate outcome and costs of treatment. In the baseline analysis, Peg-IFN/RBV treatment prevented organ loss/death, gained quality-adjusted lifeyears (QALYs) and undercut the limit of cost-effectiveness of €50 000/QALY with an incremental cost-effectiveness ratio of approximately €40 400/QALY and €21 000/QALY for HCV genotype 1 and 2/3 patients, respectively. Furthermore, sensitivity analysis testing modified model parameters according to extreme data described in the literature confirmed cost-effectiveness for a lower or higher rate of fibrosis progression, increased non-HCV-related mortality, lower limits of utilities, a time horizon of 30 years, and additional costs in the year of death. On the other hand, cost-effectiveness was lost for patients with genotype 1 in case of doubled antiviral or life-time costs or an increased discount rate of 7%. New treatment strategies for HCV genotype 1 infected patients remained on the same level cost-effective, if additional costs did not exceed €10 774 per 10% sustained virologic response gain. We conclude that Peg-IFN/RBV treatment is cost-effective post transplant. This may support treatment decision in individual cases.

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“…4 Previous studies have assessed the use of interferon-based agents to treat HCV infection in patients while they wait for liver transplant and after transplant. 5 However, widespread use of interferon has been limited by safety, tolerability, and efficacy concerns. Moreover, interferon is contraindicated in patients with advanced liver disease, particularly when used with firstgeneration protease inhibitors.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Saab

Jimenez²,

Fong³

et al. 2016

Exp Clin Transplant

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Objectives: Hepatitis C virus infection is the most common underlying reason for hepatocellular carcinoma and indication for liver transplant. The increased availability of non-interferon-based therapy has expanded the number of treatment-eligible patients. Materials and Methods:We used a decision analysis model to compare 2 strategies of treating hepatitis C virus. Included patients were followed for 1 year after liver transplant. The probabilities and costs were obtained from a literature review, an expert panel, and our institution's experience. Sensitivity analyses were performed on all variables. Results: Our model demonstrated that it would be less costly to treat patients after liver transplant than to treat patients while they wait for transplant. When we compared baseline values, the cost difference between the 2 strategies was $25,011 per patient and $41,535 per sustained viral response. Overall survival was 60.1% for both strategies. Our model was robust across most of the variables tested in the sensitivity analysis. Conclusions: Our results indicated that there is no substantial pharmacoeconomic or survival advan tage of treating hepatitis C virus in patients with compensated cirrhosis and hepatocellular carcinoma before liver transplant versus after transplant.

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Timing of hepatitis C antiviral therapy in patients with advanced liver disease: A decision analysis model

Cited by 55 publications

References 84 publications

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Cost-effectiveness analysis of antiviral treatment in liver transplant recipients with HCV infection

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