chronic hepatitis C with direct-acting antivirals (DAAs) can lead to substantial
savings by preventing the development of liver failure and liver cancer,
according to a mathematical modelling study presented at the AASLD
Liver Meeting last month in Washington, DC.
Over years or decades chronic hepatitis C virus (HCV)
infection can lead to serious liver disease including cirrhosis (scarring of
the liver), hepatocellular carcinoma (HCC; a type of primary liver cancer) and
decompensated liver disease (when the liver can no longer carry out its vital
The advent of DAAs has made hepatitis C treatment shorter, better tolerated and
much more effective compared with the old interferon-based therapy. Successful hepatitis
C treatment can halt liver disease progression, but it cannot always fully
reverse existing liver damage. People who already have cirrhosis when they
start treatment remain at risk for liver cancer even after being cured.
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
- hepatocellular carcinoma (HCC)
Liver cancer. A long-term complication of chronic inflammation of the liver or cirrhosis.
But hepatitis C treatment is expensive, so
policymakers and insurance providers want evidence that it will break even or save
money on other care over the long run, known as cost-effectiveness.
Zobair Younossi of Inova Fairfax Hospital in
Virginia and colleagues developed a mathematical model to estimate the economic benefits of curing hepatitis and
thereby reducing the occurrence of liver cancer and decompensated cirrhosis in
Japan. Liver cancer is a leading cause of death in Japan, with around 70% of cases attributable to HCV infection.
Compared with many
other countries, where HCV infection is most common among 'baby boomers' (as in
the US) or younger people who inject drugs, HCV prevalence in Japan is higher
among older people, Younossi explained as background. Many elderly people with
hepatitis C were infected decades ago (likely due to unsterile medical
equipment) and have had more time to develop advanced liver disease. In
contrast, people with chronic hepatitis C in Europe and the US are at an earlier
stage of disease, on average, and have not yet developed as many complications.
considered a hypothetical cohort of 10,000 Japanese people with an average
age of 60 who had chronic HCV genotype 1b infection (the most common type in
Japan). The model assumed that 15% of the group had progressed to cirrhosis and
that 20% had tried previous treatment.
The model compared
treatment using any approved interferon-free DAA regimen versus no treatment.
Efficacy was assumed to be similar to that seen in randomised clinical trials –
greater than 95% for easy-to-treat genotype 1b. The model was used to compare
the number of cases of decompensated cirrhosis and HCC avoided – and their
associated cost – as well as the number of quality-adjusted life years gained
for treated and untreated people.
DAA treatment prevented
1495 cases of decompensated cirrhosis, saving ¥341,645 per treated patient, as
well as 2078 cases of HCC, saving ¥857,946 per
patient. Together, treatment prevented 3573 cases of both of these
hepatitis C complications, saving ¥1,199,592 per patient, equivalent to about £8061,
In addition to
these direct savings from avoiding the cost of care for advanced liver disease,
DAA treatment also led to gain of 2.67 quality-adjusted life years per patient,
with an indirect economic benefit ranging from ¥10,680,000 to ¥16,020,000 per
total economic savings of treatment with DAAs compared to no treatment ranged
from ¥11,879,592.6 to ¥17,219,592 (about £115,718, €129,381 or US$154,373
at the high end).
Based on these
findings, Younossi's team concluded, "Treatment of HCV genotype 1 with all-oral
DAAs in Japan can lead to significant direct and indirect savings related to
avoidance of HCC and decompensated cirrhosis."