Societal perspectives analysis for evaluating direct‐acting antiviral affordability while awaiting liver transplant

Abstract

We read with interest the study by Ahmed et al. (1) identifying the cost-effectiveness of all direct-acting antivirals (DAAs) for patients with hepatitis C virus (HCV) awaiting liver transplant (LT) in the United States.A few things should be considered before applying the findings of Ahmed et al. (1) to clinical practice. There are possible selection biases in the base case scenario, for example, the ASTRAL-4 cohort, (2) which may not reflect the full spectrum of the US population. The ASTRAL-4 study (2) included a predominantly white population (90%) According to the United Network of Organ Sharing database in year 2016, approximately 20% of LT waitlist cases resulted in death or removal from the waitlist. The proportion of DAA users among HCV patients awaiting LT is largely unknown. Uncertainty remains regarding the Trump administration's actions on DAA coverage for patients with HCV waiting LT. In these contexts, Kieslich et al. (5) suggested that both the patient and the public should be proactively engaged to promote DAA coverage for HCV treatment as an urgent agenda for the media and policymakers. Simultaneously, newer costeffectiveness analyses of DAA coverage should be tested again, ideally by two reference case perspectives-the societal and payers' perspectives-and should be put forward to identify the most affordable ways to cover DAAs for US patients with HCV awaiting LT. (6)