B Njei1,2, T R McCarty3, B E Fortune1, J K Lim4. 1. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. 2. Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, CT, USA. 3. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. 4. Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. joseph.lim@yale.edu.
Abstract
BACKGROUND: Recurrence of hepatitis C virus (HCV) following liver transplantation (LT) is universal for those with ongoing viraemia and is associated with higher rates of allograft failure and death. However, the optimal timing of HCV treatment for patients awaiting transplant remains unclear. AIM: To evaluate the comparative cost-effectiveness of treating HCV pre-LT vs. post-LT (pre-emptive or after HCV recurrence). METHODS: A Markov state-transition model was created to simulate the progression of a cohort of HCV-genotype 1 or 4 cirrhotic patients from the time of transplant listing until death. We then used this model to study the cost-effectiveness of ledipasvir-sofosbuvir (LDV/SOF) with ribavirin for 12 weeks, administered for three separate treatment strategies: (i) pre-LT; (ii) post-LT preemptively prior to HCV recurrence; or (iii) post-LT after HCV recurrence. RESULTS: In the base-case analysis using a median model for end-stage liver disease (MELD) score <25 at the time of transplant, we found that pre-LT treatment of HCV led to more QALYs for fewer dollars compared to other strategies. Analysis limited to living donor LT recipients revealed that pre-LT treatment was also the most cost-effective strategy. When the analysis was repeated for MELD ≥25, decompensated disease (Child-Pugh class B or C), and hepatocellular carcinoma cases, preemptive post-LT strategy was more cost-effective. CONCLUSIONS: Treatment of HCV prior to liver transplantation appears to be the most cost-effective strategy for patients with a MELD score <25. For patients with a MELD ≥25 or decompensated cirrhosis, preemptive post-liver transplantation treatment before HCV recurrence is the most cost-effective strategy.
BACKGROUND: Recurrence of hepatitis C virus (HCV) following liver transplantation (LT) is universal for those with ongoing viraemia and is associated with higher rates of allograft failure and death. However, the optimal timing of HCV treatment for patients awaiting transplant remains unclear. AIM: To evaluate the comparative cost-effectiveness of treating HCV pre-LT vs. post-LT (pre-emptive or after HCV recurrence). METHODS: A Markov state-transition model was created to simulate the progression of a cohort of HCV-genotype 1 or 4 cirrhotic patients from the time of transplant listing until death. We then used this model to study the cost-effectiveness of ledipasvir-sofosbuvir (LDV/SOF) with ribavirin for 12 weeks, administered for three separate treatment strategies: (i) pre-LT; (ii) post-LT preemptively prior to HCV recurrence; or (iii) post-LT after HCV recurrence. RESULTS: In the base-case analysis using a median model for end-stage liver disease (MELD) score <25 at the time of transplant, we found that pre-LT treatment of HCV led to more QALYs for fewer dollars compared to other strategies. Analysis limited to living donor LT recipients revealed that pre-LT treatment was also the most cost-effective strategy. When the analysis was repeated for MELD ≥25, decompensated disease (Child-Pugh class B or C), and hepatocellular carcinoma cases, preemptive post-LT strategy was more cost-effective. CONCLUSIONS: Treatment of HCV prior to liver transplantation appears to be the most cost-effective strategy for patients with a MELD score <25. For patients with a MELD ≥25 or decompensated cirrhosis, preemptive post-liver transplantation treatment before HCV recurrence is the most cost-effective strategy.
Authors: Sumeyye Samur; Brian Kues; Turgay Ayer; Mark S Roberts; Fasiha Kanwal; Chin Hur; Drew Michael S Donnell; Raymond T Chung; Jagpreet Chhatwal Journal: Clin Gastroenterol Hepatol Date: 2017-06-17 Impact factor: 11.382
Authors: Basile Njei; Denise Esserman; Supriya Krishnan; Michael Ohl; Janet P Tate; Ronald G Hauser; Tamar Taddei; Joseph Lim; Amy C Justice Journal: Med Care Date: 2019-04 Impact factor: 2.983
Authors: James Salazar; Varun Saxena; James G Kahn; John P Roberts; Neil Mehta; Michael Volk; Jennifer C Lai Journal: Transplantation Date: 2017-05 Impact factor: 4.939
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