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Should we treat acute hepatitis C? A decision and cost‐effectiveness analysis
Author(s) -
Bethea Emily D.,
Chen Qiushi,
Hur Chin,
Chung Raymond T.,
Chhatwal Jagpreet
Publication year - 2018
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.29611
Subject(s) - medicine , hepatitis c virus , intensive care medicine , hepatitis c , quality adjusted life year , cost effectiveness , chronic hepatitis , cost–benefit analysis , immunology , virus , risk analysis (engineering) , ecology , biology
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 $483 in patients not at risk of transmitting HCV. The resulting incremental cost‐effectiveness ratio was $19,991 per QALY, demonstrating that treatment of acute HCV was cost‐effective using a willingness‐to‐pay threshold of $100,000 per QALY. In patients at risk of transmitting HCV, treating acute HCV became cost‐saving, increasing QALYs by 0.03 and decreasing costs by $3,655. 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. (H epatology 2018;67:837–846)