Early treatment of hepatitis C virus improves health outcomes and yields cost-savings: a modeling study in Argentina

SANCHEZ, Y; ALBAYTERO MN; KANEVSKY, D; ELGART, JF; MENDIZABAL, M; RODRIGUEZ, MF; GLANCSZPIGEL M

Congreso; Digital International Liver Congress 2020; 2020

EASL - European Association for the Study of the Liver

Background and aims: Patients with hepatitis C virus (HCV) face increased healthcare costs due to hepatic and extrahepatic complications. The new all-oral direct-acting antivirals have dramatically improved the sustained virological response (SVR) rates. Achieving SVR has shown to increase health benefits and reduce medical costs.While treatment in early stages of liver fibrosis has been shown to reduce liver-related complications and lower healthcare costs compared to treatment in later disease stages, it is often delayed and patients in early fibrosis stages have limited access to effective treatment. Thus, this study evaluated the clinical and economic impact of treating patients in Argentina with HCV at early vs late stages of liver disease.Method: A Markov model of the natural history of HCV was used to forecast liver-related and economic outcomes over a lifetime from the perspective of Argentina?s social security sector. Health utilities and transition probabilities were drawn from published literature. Treatment attributes and patient demographics were based on registrational clinical trials of glecaprevir/pibrentasvir. Costs were based on tariffs from Argentina?s social security system. Analyses were conducted for patients with HCV genotypes 1-6 and different fibrosis stages of liver disease: mild (F0?F1); moderate (F2?F3), and compensated cirrhosis (F4). Health outcomes included lifetime risks of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), liver transplant (LT), and liver-related death (LrD). Other outcomes included lifetime costs and quality-adjusted life years (QALYs), both discounted at a 5% rate.Results: In this simulated model, treating HCV infection at early stages of fibrosis appeared to reduce the risk of CC, DCC, HCC, LT and LrD (Table). Delaying treatment increased long-term total lifetime costs and provided fewer QALYs. Early treatment was a dominant strategy regardless of time of delay as it delivered more QALYs at lower costs.Conclusion: This analysis suggests that treating HCV at early stages improves health outcomes and reduces the total cost in Argentina. Hence, clinical and policy decision-makers should avoid delays and restrictions in HCV treatment.