Cost-Effectiveness of DAA Therapy in Liver Transplant Candidates
DAAs appear to be cost-effective when used prior to liver transplantation in patients with decompensated cirrhosis and MELD scores ≤20.
Treating the hepatitis C virus (HCV) with direct-acting antivirals (DAAs) prior to liver transplantation (LT) is more cost-effective than initiating DAAs at the time of LT or at disease recurrence in patients with decompensated cirrhosis (DCC) or hepatocellular carcinoma (HCC), according to study findings published in the Journal of Viral Hepatitis.
Researchers developed a decision-analytical model to simulate HCV progression in patients with either DCC or HCC. Using this simulation, the investigators compared a 12-week course of DAA therapy before LT (PRE-LT), a 4-week course of DAAs initiated at the time of transplantation (PERI-LT), and a 12-week course of DAAs initiated at disease recurrence (POST-LT). Investigators also categorized patients with HCC and patients without HCC according to their MELD score (MELD <16, MELD 16 to 20, and MELD >20).
The use of DAAs prior to LT was most common in patients with DCC and a MELD score of <16. In addition, using DAAs before LT was more cost-effective in patients with a MELD score of 16 to 20. Conversely, a course of DAAs initiated at disease recurrence was the most cost-effective in patients with DCC with a MELD score >20, as well as in patients with HCC.
In patients with a MELD score of ≤20 without HCC, a PRE-LT strategy was confirmed as the most cost-effective based on sensitivity analyses.
In this analysis, the investigators did not factor in genotype 3 HCV, which may limit the findings to the other genotypes assessed. In addition, the investigators did not evaluate participants' long-term survival, considering these data are limited in LT recipients achieving a sustained virologic response.
The investigators suggest that the “final choice of a specific regimen for a specific patient will ultimately have to be personalized and based on clinical, social, and transplant-related factors.”
Cortesi PA, Belli LS, Facchetti R, et al; European Liver and Intestine Transplant Association (ELITA). The optimal timing of hepatitis C therapy in liver transplant eligible patients: cost-effectiveness analysis of new opportunities [published online February 6, 2018]. J Viral Hepat. doi:10.1111/jvh.12877