The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients with Child B and C Cirrhosis: A Cost-Effectiveness Analysis

Tapper, Elliot B.; Hughes, Melody; Buti, María; Dufour, J.-F.; Flamm, S.; Curry, Michael P.; Afdhal, N.

doi:10.1016/s0168-8278(16)01562-2

Cited by 14 publications

(22 citation statements)

References 9 publications

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“…Other studies have investigated the optimal timing of DAA treatment for patients listed for transplant, using a decision analytical model . The first was the study by Njei et al that considered only patients with decompensated cirrhosis without HCC.…”

Section: Discussionmentioning

confidence: 99%

“…From this study, treating patients before LT emerged as the most cost‐effective for patients with MELD<25. A second study by Tapper et al compared the cost‐effectiveness of a 12‐week course of sofosbuvir and ledipasvir before or after LT in patients with decompensated cirrhosis without HCC. This study also confirms that treatment prior to LT is the most cost‐effective for patients with a MELD>10.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis is not limited to any particular DAAs combination based on the fact that all the current ones are equally very effective. A PRE‐LT HCV‐RNA clearance of 90% was derived from the European Liver and Intestine Transplant Association (ELITA) and Tapper et al studies. While an SVR of 88% has been demonstrated for patients treated PERI‐LT, and an SVR of 96% in patients treated POST‐LT when developing F3 fibrosis was based on data reported by Charlton et al (Table ).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The optimal timing of hepatitis C therapy in liver transplant‐eligible patients: Cost‐effectiveness analysis of new opportunities

Cortesi

Belli

Facchetti

et al. 2018

Journal of Viral Hepatitis

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Different strategies of DAAs treatment are currently possible both pre- and postliver transplantation (LT). Clinical and economic consequences of these strategies still need to be adequately investigated; this study aims at assessing their cost-effectiveness. A decision analytical model was created to simulate the progression of HCV-infected patients listed for decompensated cirrhosis (DCC) or for hepatocellular carcinoma (HCC). Three DAAs treatment strategies were compared: (i) a 12-week course of DAAs prior to transplantation (PRE-LT), (ii) a 4-week course of DAAs starting at the time of transplantation (PERI-LT) and (iii) a 12-week course of DAAs administered at disease recurrence (POST-LT). The population was substratified according to HCC presence and, in those without HCC, according to the MELD score at listing. Data on DAAs effectiveness were estimated using a cohort of patients still followed by 11 transplant centres of the European Liver and Intestine Transplant Association and by data available in the literature. In this study, PRE-LT treatment strategy was dominant for DCC patients with MELD<16 and cost-effective for those with MELD16-20, while POST-LT strategy emerged as cost-effective for DCC patients with MELD>20 and for those with HCC. Sensitivity analyses confirmed PRE-LT as the cost-effective strategy for patients with MELD≤20. In conclusion, PRE-LT treatment is cost-effective for patients with MELD≤20 without HCC, while treatments after LT are cost-effective in cirrhotic patients with MELD>20 and in those with HCC. It is worth reminding, though, that the final choice of a specific regimen at the patient level will have to be personalized based on clinical, social and transplant-related factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The optimal timing of hepatitis C therapy in liver transplant‐eligible patients: Cost‐effectiveness analysis of new opportunities

Cortesi

Belli

Facchetti

et al. 2018

Journal of Viral Hepatitis

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“…In the human immunodeficiency virus-HCV coinfected population, the interferon-free regimen with a combination of ombitasvir/paritaprevir/ritonavir with or without ribavirin was found to be the most effective in preventing excessive adverse clinical outcomes and deaths; that regimen was also found to be more cost-effective in comparison with LDV/SOF in anti-HCV treatment-naïve human immunodeficiency virus-HCV patients. 14 The cost-effectiveness of sofosbuvir-based therapy was also confirmed in incarcerated patients, 11 patients with decompensated cirrhosis, 13 and posttransplant patients. 33 One report from the Netherlands suggested cost-effectiveness of treating patients who inject drugs with DAAs, primarily because curing their infection would reduce HCV epidemics in that population.…”

Section: Stepanova and Younossimentioning

confidence: 92%

“…At the same time, in the scientific literature, the value of a cure with DAAs has been being extensively studied in multiple economic models developed for different clinical populations in a number of countries. [4][5][6][7][8][9][10][11][12][13][14] There are several different approaches to evaluating the economic impact of a chronic disease and its treatment. The simplest is a budgetary cost analysis where only immediate costs of treatment, such as the costs of the drug, its adverse events, and expected use of health care resources, are considered.…”

Section: Economics Of Chronic Hepatitis C Treatmentmentioning

confidence: 99%

Economic Burden of Hepatitis C Infection

Stepanova

Younossi

2017

Clinics in Liver Disease

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Management of Hepatitis C in Special Populations: HIV Coinfection, Renal Disease, and Decompensated Cirrhosis

Lim

2020

Clinical Liver Disease

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The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients with Child B and C Cirrhosis: A Cost-Effectiveness Analysis

Cited by 14 publications

References 9 publications

The optimal timing of hepatitis C therapy in liver transplant‐eligible patients: Cost‐effectiveness analysis of new opportunities

The optimal timing of hepatitis C therapy in liver transplant‐eligible patients: Cost‐effectiveness analysis of new opportunities

Economic Burden of Hepatitis C Infection

Management of Hepatitis C in Special Populations: HIV Coinfection, Renal Disease, and Decompensated Cirrhosis

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