Achieving sustained virologic response in hepatitis C: a systematic review of the clinical, economic and quality of life benefits

Abstract

BackgroundThe goal of chronic hepatitis C treatment is to remove the virus to avoid progression of HCV-related disease. Sustained virologic response (SVR) is the most widely used efficacy endpoint in clinical studies of hepatitis C, and represents the eradication of HCV from the body. The aim of the current review was to examine the long-term clinical, economic and quality of life benefits associated with achieving SVR.MethodsA systematic literature review was performed using the PubMed, EMBASE and Cochrane library databases to identify articles examining the clinical, economic and quality of life benefits associated with SVR, published in English language from 2002–2013. For inclusion studies were required to enroll ≥100 patients and to report clinical endpoints including hepatocellular carcinoma, overall- or liver-related mortality, or progression of disease/complications (e.g. portal hypertension, esophageal varices). Review of economic studies on cost/cost-effectiveness of achieving SVR were focused on studies assessing boceprevir/telaprevir plus pegIFN and ribavirin as this represents the current standard of care in several jurisdictions worldwide. Quality of life evidence was required to use validated quality of life instruments and provide a quantitative analysis of the impact of SVR versus no treatment or treatment failure.ResultsSVR is durable with late relapse rates over 4–5 year periods being in the range of 1–2%. Patients who achieve SVR frequently demonstrate some regression of fibrosis/cirrhosis and have a substantially reduced risk for hepatocellular carcinoma (relative risk [RR] 0.1–0.25), liver-related mortality (RR 0.03–0.2) and overall mortality (RR 0.1–0.3) in comparison with no treatment or treatment failure. In the 5 years post-treatment, medical costs for patients achieving SVR are 13-fold lower than patients not achieving SVR. Patients who achieve SVR also have health state utility values that are 0.05 to 0.31 higher than non-responders to treatment.ConclusionsSVR represents the fundamental goal of antiviral treatment for patients infected with chronic HCV, so as to reduce risk of liver disease progression. Achievement of SVR has implications beyond those of clearing viral infection; it is associated with improved long-term clinical outcomes, economic benefits and improved health-related quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0748-8) contains supplementary material, which is available to authorized users.

Health-Related Quality of Life in patients with hepatitis C in double and triple therapy

“…In a systematic review including 15 studies, patients with chronic hepatitis C without signs of advanced disease declined in HRQoL of the SF-36 in both physical and mental component summary (21) . As expected in patients with liver cirrhosis, the HRQoL reduction is even greater (22)(23) . Until recently, the standard therapy of chronic hepatitis C was a PEG-IFN and ribavirin combination.…”

Buying cures versus renting health: Financing health care with consumer loans

“…S3 and S4). Studies on interferon and ribavirin treatment for chronic HCV infection have reported that all-cause mortality rates for patients with a sustained virological response-which equates to cure in nearly all cases-are not statistically different from those of an age-matched general population (12)(13)(14). Therefore, we used general-population mortality rates as a proxy for patients who receive new HCV-directed therapies (15,16).…”

Hepatitis C virus mediated chronic inflammation and tumorigenesis in the Humanised Immune system and Liver mouse model

“…One of the milestones in HCV research is the recent discovery of direct acting antivirals against HCV which, when used in appropriate combinations is effective against various genotypes of HCV in infected individuals [9][10][11][12][13]. Although patients who achieve sustained virologic response (SVR) have a substantially reduced risk of HCC [14] and it is hopeful that we will soon be able to achieve SVR in most HCV infected patients, the precise mechanisms of HCV pathogenesis are still not well understood. Furthermore, a proportion of patients who achieved SVR still develop HCC [15][16][17], hence, a better understanding of HCV pathogenesis is required for the development of therapeutic strategies to manage viral mediated tumorigenesis.…”