What Is the Optimal Timing of Hepatitis C Antiviral Therapy Before and After Liv

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What Is the Optimal Timing of Hepatitis C Antiviral Therapy Before and After

Liver Transplantation? Presented at AASLD

By Cheryl Lathrop

http://www.docguide.com/news/content.nsf/news/852576140048867A85257664005EE22B

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,

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.