Should we treat acute hepatitis C? A decision and... : Hepatology (original) (raw)

Original Articles: VIRAL HEPATITIS

Should we treat acute hepatitis C? A decision and cost‐effectiveness analysis

Bethea, Emily D.1,2,3,†; Chen, Qiushi1,2,†; Hur, Chin1,2,3; Chung, Raymond T.2,3; Chhatwal, Jagpreet*,1,2,3

1Massachusetts General Hospital Institute for Technology AssessmentBostonMA

2Harvard Medical SchoolBostonMA

3Liver Center and Gastrointestinal DivisionMassachusetts General HospitalBostonMA

* ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO:
Jagpreet Chhatwal, Ph.D.
MGH Institute for Technology Assessment
101 Merrimac Street
10th Floor
Boston, MA 02114
E‐mail: [email protected]
Tel: +1‐617‐724‐4445

†These authors contributed equally.

Abstract

It is not standard practice to treat patients with acute hepatitis C virus (HCV) infection. However, as the incidence of HCV in the United States continues to rise, it may be time to re‐evaluate acute HCV management in the era of direct‐acting antiviral (DAA) agents. In this study, a microsimulation model was developed to analyze the trade‐offs between initiating HCV therapy in the acute versus chronic phase of infection. By simulating the lifetime clinical course of patients with acute HCV infection, we were able to project long‐term outcomes such as quality‐adjusted life years (QALYs) and costs. We found that treating acute HCV versus deferring treatment until the chronic phase increased QALYs by 0.02 and increased costs by 483inpatientsnotatriskoftransmittingHCV.Theresultingincrementalcost‐effectivenessratiowas483 in patients not at risk of transmitting HCV. The resulting incremental cost‐effectiveness ratio was 483inpatientsnotatriskoftransmittingHCV.Theresultingincrementalcost‐effectivenessratiowas19,991 per QALY, demonstrating that treatment of acute HCV was cost‐effective using a willingness‐to‐pay threshold of 100,000perQALY.InpatientsatriskoftransmittingHCV,treatingacuteHCVbecamecost‐saving,increasingQALYsby0.03anddecreasingcostsby100,000 per QALY. In patients at risk of transmitting HCV, treating acute HCV became cost‐saving, increasing QALYs by 0.03 and decreasing costs by 100,000perQALY.InpatientsatriskoftransmittingHCV,treatingacuteHCVbecamecost‐saving,increasingQALYsby0.03anddecreasingcostsby3,655. Conclusion: Immediate treatment of acute HCV with DAAs can improve clinical outcomes and be highly cost‐effective or cost‐saving compared with deferring treatment until the chronic phase of infection. If future studies continue to demonstrate effective HCV cure with shorter 6‐week treatment duration, then it may be time to revisit current HCV guidelines to incorporate recommendations that account for the clinical and economic benefits of treating acute HCV in the era of DAAs. (Hepatology 2018;67:837–846)