The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients With Child B and C Cirrhosis : A Cost-Effectiveness Analysis
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:101 |
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| Enthalten in: |
Transplantation - 101(2017), 5 vom: 05. Mai, Seite 987-995 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tapper, Elliot B [VerfasserIn] |
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| Links: |
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| Themen: |
49717AWG6K |
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| Anmerkungen: |
Date Completed 16.08.2017 Date Revised 09.12.2020 published: Print Citation Status MEDLINE |
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| doi: |
10.1097/TP.0000000000001400 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM263165035 |
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| 100 | 1 | |a Tapper, Elliot B |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The Optimal Timing of Hepatitis C Therapy in Transplant Eligible Patients With Child B and C Cirrhosis |b A Cost-Effectiveness Analysis |
| 264 | 1 | |c 2017 | |
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| 500 | |a Date Revised 09.12.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Antiviral Agents |2 NLM | |
| 650 | 7 | |a Benzimidazoles |2 NLM | |
| 650 | 7 | |a Fluorenes |2 NLM | |
| 650 | 7 | |a ledipasvir, sofosbuvir drug combination |2 NLM | |
| 650 | 7 | |a Ribavirin |2 NLM | |
| 650 | 7 | |a 49717AWG6K |2 NLM | |
| 650 | 7 | |a Uridine Monophosphate |2 NLM | |
| 650 | 7 | |a E2OU15WN0N |2 NLM | |
| 650 | 7 | |a Sofosbuvir |2 NLM | |
| 650 | 7 | |a WJ6CA3ZU8B |2 NLM | |
| 700 | 1 | |a Hughes, Michael S |e verfasserin |4 aut | |
| 700 | 1 | |a Buti, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Dufour, Jean-Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Flamm, Steve |e verfasserin |4 aut | |
| 700 | 1 | |a Firdoos, Saima |e verfasserin |4 aut | |
| 700 | 1 | |a Curry, Michael P |e verfasserin |4 aut | |
| 700 | 1 | |a Afdhal, Nezam H |e verfasserin |4 aut | |
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