Source: DGNews  |  Posted 2 years ago

By Cheryl Lathrop

BOSTON -- November 4, 2009 -- Treatment with pegylated interferon and ribavirin
(PEG/RBV) therapy during compensated cirrhosis is the most cost-effective
strategy for antiviral administration in the setting of advanced hepatitis C
virus (HCV)-related liver disease, researchers noted here at the Liver Meeting
2009, the 60th Annual Meeting of the American Association for the Study of
Liver Diseases (AASLD).

This strategy yields the greatest survival benefit with the lowest associated
cost; it reverses cirrhosis, and prevents decompensation, transplantation,
hepatocellular carcinoma (HCC), and death. Sammy Saab, MD, MPH, David Geffen
School of Medicine, University of California, Los Angeles, Los Angeles,
California, and colleagues reported evidence from their study for treating HCV
in patients with compensated cirrhosis before it progresses to more advanced
liver disease. The poster presentation was held here on October 31.

Antiviral therapy for the treatment of HCV infection is used both before and
after liver transplantation. The objective of this study was to determine the
ideal timing for PEG/RBV therapy in patients with advanced liver disease
infected with genotype 1 HCV.

The 4 treatment groups were as follows: (1) no antiviral treatment, (2)
antiviral therapy in patients with compensated cirrhosis, (3) antiviral therapy
in patients with decompensated cirrhosis, and (4) antiviral therapy in patients
with recurrent HCV post transplant. A Markov model was constructed comparing
treatment strategies. Outcomes of interest were total cost per patient, number
of quality-adjusted life-years (QALYs) saved, number of deaths, number of HCCs,
and number of transplants required. Each of the 4 treatment arms comprised
1,000 patients.

The total cost per patient for treatment during compensated cirrhosis was
$331,425; the total cost per patient for each of the other 3 treatment groups
was approximately $152,000 more. The life expectancy for treatment during
compensated cirrhosis was almost 10 QALY; for the other 3 groups it was about 7
QALY.

In the 10-year outcome data, a total of approximately 250 patients died in the
compensated cirrhosis treatment group; approximately 500 patients died in each
of the other 3 groups. A total of approximately 175 patients had a transplant
in the compensated cirrhosis treatment group; approximately 200 patients had a
transplant in each of the other 3 groups. About 50 patients had regression of
cirrhosis in the compensated-cirrhosis treatment group.

Treatment of patients with compensated cirrhosis was the most cost-effective
strategy; it resulted in improved survival and decreased cost when compared
with the other 3 strategies. Treatment after development of decompensated
cirrhosis or post transplant was also cost-effective, but these patients
derived less survival benefit at greater cost (when compared with patients
treated during compensated cirrhosis). Patients who were allowed to develop
more advanced disease had a considerably worse prognosis. All 3 treatment
strategies appeared more cost-effective than “no treatment,” which suggests
that these patients may benefit from antiviral treatment.

“Given these results, we strongly recommend expeditious administration of
antiviral therapy to patients with compensated cirrhosis before their disease
advances,” the authors stated.

These treatment strategies must be studied further, however, before they can be
universally recommended, they advised.

Presentation title: Timing of Hepatitis C Antiviral Therapy Pre and Post
Liver Transplantation: A Decision Analysis Model. Abstract 503