Optimal timing for hepatitis C therapy in US patients eligible for liver transplantation: a cost-effectiveness analysis

被引:16
|
作者
Njei, B. [1 ,2 ]
McCarty, T. R. [3 ]
Fortune, B. E. [1 ]
Lim, J. K. [1 ]
机构
[1] Yale Univ, Sch Med, Sect Digest Dis, 333 Cedar St,LMP 1080, New Haven, CT 06520 USA
[2] Yale Ctr Clin Invest, Invest Med Program, New Haven, CT USA
[3] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA
关键词
ALPHA-2B PLUS RIBAVIRIN; GENOTYPE; INFECTION; RECURRENT HEPATITIS; UNITED-STATES; HCV INFECTION; PEGYLATED INTERFERON-ALPHA-2B; PEGINTERFERON ALPHA-2B; NATURAL-HISTORY; VIRUS-INFECTION; ANTIVIRAL THERAPY;
D O I
10.1111/apt.13798
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Recurrence of hepatitis C virus (HCV) following liver transplantation (LT) is universal for those with ongoing viraemia and is associated with higher rates of allograft failure and death. However, the optimal timing of HCV treatment for patients awaiting transplant remains unclear. Aim To evaluate the comparative cost-effectiveness of treating HCV pre-LT vs. post-LT (pre-emptive or after HCV recurrence). Methods A Markov state-transition model was created to simulate the progression of a cohort of HCV-genotype 1 or 4 cirrhotic patients from the time of transplant listing until death. We then used this model to study the cost-effectiveness of ledipasvir-sofosbuvir (LDV/SOF) with ribavirin for 12 weeks, administered for three separate treatment strategies: (i) pre-LT; (ii) post-LT preemptively prior to HCV recurrence; or (iii) post-LT after HCV recurrence. Results In the base-case analysis using a median model for end-stage liver disease (MELD) score <25 at the time of transplant, we found that pre-LT treatment of HCV led to more QALYs for fewer dollars compared to other strategies. Analysis limited to living donor LT recipients revealed that preLT treatment was also the most cost-effective strategy. When the analysis was repeated for MELD >= 25, decompensated disease (Child-Pugh class B or C), and hepatocellular carcinoma cases, preemptive post-LT strategy was more cost-effective. Conclusions Treatment of HCV prior to liver transplantation appears to be the most cost-effective strategy for patients with a MELD score <25. For patients with a MELD >= 25 or decompensated cirrhosis, preemptive post-liver transplantation treatment before HCV recurrence is the most cost-effective strategy.
引用
收藏
页码:1090 / 1101
页数:12
相关论文
共 50 条
  • [1] The optimal timing of hepatitis C therapy in liver transplant-eligible patients: Cost-effectiveness analysis of new opportunities
    Cortesi, P. A.
    Belli, L. S.
    Facchetti, R.
    Mazzarelli, C.
    Perricone, G.
    De Nicola, S.
    Cesana, G.
    Duvoux, C.
    Mantovani, L. G.
    Strazzabosco, M.
    JOURNAL OF VIRAL HEPATITIS, 2018, 25 (07) : 791 - 801
  • [2] THE OPTIMAL TIMING OF HEPATITIS C THERAPY IN TRANSPLANT ELIGIBLE PATIENTS WITH CHILD B AND C CIRRHOSIS: A COST-EFFECTIVENESS ANALYSIS
    Tapper, E. B.
    Hughes, M.
    Buti, M.
    Dufour, J. -F.
    Flamm, S.
    Curry, M.
    Afdhal, N.
    JOURNAL OF HEPATOLOGY, 2016, 64 : S800 - S800
  • [3] The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients With Child B and C Cirrhosis: A Cost-Effectiveness Analysis
    Tapper, Elliot B.
    Hughes, Michael
    Buti, Maria
    Dufour, Jean-Francois
    Flamm, Steven
    Curry, Michael
    Afdhal, Nezam H.
    GASTROENTEROLOGY, 2016, 150 (04) : S1161 - S1161
  • [4] The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients With Child B and C Cirrhosis: A Cost-Effectiveness Analysis
    Tapper, Elliot B.
    Hughes, Michael S.
    Buti, Maria
    Dufour, Jean-Francois
    Flamm, Steve
    Firdoos, Saima
    Curry, Michael P.
    Afdhal, Nezam H.
    TRANSPLANTATION, 2017, 101 (05) : 987 - 995
  • [5] Optimal Timing for Hepatitis C Treatment in Cirrhotic Patients Awaiting Liver Transplantation: A Cost-Effectiveness Analysis
    Njei, Basile
    McCarty, Thomas R.
    Ditah, Ivo C.
    Lim, Joseph K.
    Fortune, Brett E.
    GASTROENTEROLOGY, 2016, 150 (04) : S1037 - S1037
  • [6] Therapy of hepatitis C: Cost-effectiveness analysis
    Koff, RS
    HEPATOLOGY, 1997, 26 (03) : S152 - S155
  • [7] Cost-effectiveness of liver biopsy in patients with chronic hepatitis C.
    Forns, X
    Ampurdanes, S
    Bruguera, M
    Sanchez-Tapias, JM
    Rodes, J
    HEPATOLOGY, 2000, 32 (04) : 547A - 547A
  • [8] Cost-effectiveness of combination therapy for naive patients with chronic hepatitis C
    Buti, M
    Casado, MA
    Fosbrook, L
    Wong, JB
    Esteban, R
    JOURNAL OF HEPATOLOGY, 2000, 33 (04) : 651 - 658
  • [9] A cost-effectiveness analysis of universal Hepatitis C screening in all US pregnancies
    Zimmermann, Marguerite
    Hersh, Alyssa R.
    Greiner, Karen
    Chaiken, Sarina
    Caughey, Aaron B.
    AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2020, 222 (01) : S538 - S539
  • [10] Transarterial therapies in patients with hepatocellular carcinoma eligible for transarterial embolization: a US cost-effectiveness analysis
    Patel, Mikin V.
    Davies, Heather
    Williams, Abimbola O.
    Bromilow, Tom
    Baker, Hannah
    Mealing, Stuart
    Holmes, Hayden
    Anderson, Nicholas
    Ahmed, Osman
    JOURNAL OF MEDICAL ECONOMICS, 2023, 26 (01) : 1061 - 1071