For patients with non-cirrhotic chronic hepatitis C virus (HCV) infection, a more concise and simplified treatment and monitoring program not only expedites the path to HCV elimination but may also increase health benefits for patients and decrease costs to the healthcare system, according to results of a recent study.
The study, which was an open multi-cohort Markov model, aimed to analyze the clinical and economic outcomes of the United States HCV population from 2018 on. In order to do this, a screening program that diagnosed 90% of the population by 2025 was utilized. “The model tracked the progression of the 2018 diagnosed prevalent HCV population adding a cohort of incident patients annually,” the study authors described. Outcomes of the study included the number of patients with sustained virologic response (SVR), end-stage liver disease (ESLD), and liver-related death (LrD).
“The annual budget constraint was set at $7 billion (bn) applying a ‘top-down’ stepwise strategy by treating F4 fibrosis stage first and F0 last,” the study authors explained. They added, “We then compared 3 treatment and monitoring strategies for non-cirrhotic (F0-F3) patients: 12 weeks standard with 5 hepatologist visits, 8 weeks standard with 4 visits and 8 weeks simplified with 2 visits + 2 phone calls.” For F4 patients, treatment and monitoring by a hepatologist was carried out over 12 weeks.
The study authors reported that all diagnosed HCV cases would be eliminated by 2031 utilizing the 12-week treatment strategy. On the other hand, for F0-F3 patients treated by the 8-week strategies, elimination would occur by 2028. Additionally, with the 8-week treatment strategy, 146,237 additional patients (+7.0%) would achieve SVR, while 16,358 cases (-19.8%) of ESLD and 13,977 cases (-25.9%) of LrD would be avoided by 2031.
The study authors explained, “This faster elimination path generated savings of $55.6bn ($23,191 per treated patient) by 2031, 30% due to the decrease in the overall treatment cost and 70% due to the faster elimination of diagnosed HCV cases which reduced spending on hepatic and extrahepatic complications.” They added, “The simplified 8-week approach would save 3.7 million additional hepatologist visits and $0.37bn in costs.”
Based on the findings, the authors concluded that a shorter and simpler treatment program for non-cirrhotic HCV patients could accelerate HCV elimination, improve health benefits, and reduce costs to the healthcare system.
Feld JJ, Gonzalez YS, Pires AG, Ethgen O. Clinical Benefits, Economic Savings and Faster Time to HCV Elimination with a Simplified 8-Week Treatment and Monitoring Program in Chronic F0-F3 Naïve Patients in the US. Presented at AASLD The Liver Meeting 2018. Study number 0688.