Reduced healthcare utilization following successful hepatitis C virus treatment in HIV‐co‐infected patients with mild liver disease

Abstract

SummaryNew direct‐acting antivirals (DAA) for hepatitis C virus (HCV) infection have achieved high cure rates in many patient groups previously considered difficult‐to‐treat, including those HIV/HCV co‐infected. The high price of these medications is likely to limit access to treatment, at least in the short term. Early treatment priority is likely to be given to those with advanced disease, but a more detailed understanding of the potential benefits in treating those with mild disease is needed. We hypothesized that successful HCV treatment within a co‐infected population with mild liver disease would lead to a reduction in the use and costs of healthcare services in the 5 years following treatment completion. We performed a retrospective cohort study of HIV/HCV‐co‐infected patients without evidence of fibrosis/cirrhosis who received a course of HCV therapy between 2004 and 2013. Detailed analysis of healthcare utilization up to 5 years following treatment for each patient using clinical and electronic records was used to estimate healthcare costs. Sixty‐three patients were investigated, of whom 48 of 63 (76.2%) achieved sustained virological response 12 weeks following completion of therapy (SVR12). Individuals achieving SVR12 incurred lower health utilization costs (£5000 per‐patient) compared to (£10 775 per‐patient) non‐SVR patients in the 5 years after treatment. Healthcare utilization rates and costs in the immediate 5 years following treatment were significantly higher in co‐infected patients with mild disease that failed to achieve SVR12. These data suggest additional value to achieving cure beyond the prevention of complications of disease.

Healthcare resource utilization in Hepatitis C-infected patients completing eight versus twelve weeks of treatment: A retrospective cohort study

“…Comparisons of the number of healthcare encounters by encounter type are summarized in Table 3. Overall, the median number of healthcare encounters throughout treatment was 8 [interquartile range (IQR) [5][6][7][8][9][10][11][12] for those receiving a 12-week treatment regimen as compared to 6 (IQR 4-11) for those on an 8-week treatment regimen (P=0.07). Fewer laboratory visits were utilized in the 8-week group, with an average of 1.6 visits (median=1) as compared to 2.3 visits (median=2) in the 12week group (P=0.04; for comparison of medians) (Figure 2).…”

“…Previous studies have measured the healthcare costs associated with length of treatment, including expenses related to HCV treatment in those dually infected with Human Immunodeficiency Virus (HIV) (9)(10)(11). Shorter treatment times may critically reduce the financial impact on vulnerable patients and allow savings to both payors and hospital systems.…”

Update in HIV–hepatitis C virus coinfection in the direct acting antiviral era

“…While preventing hepatic decompensation and HCC are the most recognized advantages of treating HCV, a retrospective analysis of HIV/HCV patients with early liver disease between 2004–2013 indicated patients achieving SVR with IFN-based therapy had lower health-care utilization during the following 5 years, suggesting health systems value of treatment aside from prevention of hepatic complications [86]. A modelling study examining liver fibrosis progression in HCV/HIV co-infected MSM, who often have other co-morbid factors modulating fibrosis progression, suggested deferring treatment in persons who had F0–F1 disease until fibrosis had progressed to F2 or beyond would result in an increase in overall liver-related morbidity and mortality [87].…”

Optimal timing of hepatitis C treatment among HIV/HCV coinfected ESRD patients: Pre- vs posttransplant

“…[15][16][17][18] Recent studies, however, have demonstrated the multiple benefits of successful HCV treatment including reduction in risk of mortality and liver-related events as well as reductions in medical expenditures. [19][20][21] Moreover, there is evidence to suggest HIVinfected patients are at increased risk of mortality as compared to HIV negative patients. 6,22 As a result, identifying and addressing modifiable risk factors for renal disease progression and mortality is paramount in this population.…”