The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients With Child B and C Cirrhosis: A Cost-Effectiveness Analysis.

Abstract

BACKGROUND:

Ledipasvir (LDV)/sofosbuvir (SOF) has demonstrated high efficacy, safety, and tolerability in hepatitis C virus (HCV)-infected patients. There is limited data, however, regarding the optimal timing of therapy in the context of possible liver transplantation (LT).

METHODS:

We compared the cost-effectiveness of 12 weeks of HCV therapy before or after LT or nontreatment using a decision analytical microsimulation state-transition model for a simulated cohort of 10 000 patients with HCV Genotype 1 or 4 with Child B or C cirrhosis. All model parameters regarding the efficacy of therapy, adverse events and the effect of therapy on changes in model for end-stage liver disease (MELD) scores were derived from the SOLAR-1 and 2 trials. The simulations were repeated with 10 000 samples from the parameter distributions. The primary outcome was cost (2014 US dollars) per quality adjusted life year.

RESULTS:

Treatment before LT yielded more quality-adjusted life year for less money than treatment after LT or nontreatment. Treatment before LT was cost-effective in 100% of samples at a willingness-to-pay threshold of US $100 000 in the base-case and when the analysis was restricted to Child B alone, Child C, or MELD > 15. Treatment before transplant was not cost-effective when MELD was 6-10. In sensitivity analyses, the MELD after which treatment before transplant was cost-effective was 13 and the maximum cost of LDV/SOF therapy at which treatment before LT is cost-effective is US $177 381.

CONCLUSIONS:

From a societal perspective, HCV therapy using LDV/SOF with ribavirin before LT is the most cost-effective strategy for patients with decompensated cirrhosis and MELD score greater than 13.

• Authors: Elliot B Tapper, Michael S Hughes, Maria Buti, Jean-Francois Dufour, Steve Flamm, Saima Firdoos, Michael P Curry, Nezam H Afdhal
• Journal: Transplantation (Transplantation) Vol. 101 Issue 5 Pg. 987-995 (05 2017) ISSN: 1534-6080 [Electronic] United States
• PMID: 27495755 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents
• Benzimidazoles
• Fluorenes
• ledipasvir, sofosbuvir drug combination
• Ribavirin
• Uridine Monophosphate
• Sofosbuvir

Topics

• Antiviral Agents (administration & dosage, economics, therapeutic use)
• Benzimidazoles (administration & dosage, economics, therapeutic use)
• Combined Modality Therapy
• Cost-Benefit Analysis
• Decision Support Techniques
• Drug Administration Schedule
• Fluorenes (administration & dosage, economics, therapeutic use)
• Hepatitis C, Chronic (complications, drug therapy, economics, surgery)
• Humans
• Liver Cirrhosis (surgery, virology)
• Liver Transplantation
• Models, Economic
• Quality-Adjusted Life Years
• Ribavirin (administration & dosage, economics, therapeutic use)
• Sofosbuvir
• Treatment Outcome
• United States
• Uridine Monophosphate (administration & dosage, analogs & derivatives, economics, therapeutic use)