The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients With Child B and C Cirrhosis: A Cost-Effectiveness Analysis.
Transplantation
; 101(5): 987-995, 2017 05.
Article
em En
| MEDLINE
| ID: mdl-27495755
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.
Texto completo:
1
Temas:
ECOS
/
Aspectos_gerais
/
Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Antivirais
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Transplante de Fígado
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Análise Custo-Benefício
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Hepatite C Crônica
/
Cirrose Hepática
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Patient_preference
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Transplantation
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Israel