Treatment of hepatitis C with direct-acting antivirals significantly reduces liver-related hospitalizations in patients with cirrhosis. Issue 11 (November 2018)

• Record Type: Journal Article
• Authors: Hill, Lucas A.; Delmonte, Ronnie J.; Andrews, Barbara; Richards, Lisa; Soto, Robin; Collier, Summer; Kuo, Alexander; Cachay, Edward
• Is Part Of: European journal of gastroenterology & hepatology. Volume 30:Issue 11(2018:Nov.)
• Publication Date: 2018-11
• Subjects: cirrhosis -- health economics -- hepatitis C -- liver -- viral hepatitis; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000001195
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background: The availability of direct-acting antivirals (DAA) for the treatment of hepatitis C (HCV) has resulted in the ability to safely and effectively treat patients with cirrhosis and end-stage liver disease. However, information is limited with regard to the impact of DAA treatment on inpatient health-related resource utilization in patients with advanced HCV-related cirrhosis. We aimed to ascertain the impact of DAA treatment on the frequency of liver-related hospitalizations and associated costs in patients with cirrhosis. Patients and methods: Retrospective cohort analysis carried out at a single US reference center that compared patients with HCV cirrhosis according to treatment status: the untreated group (January 2011 to December 2013) and the DAA-treated group (January 2014 to March 2017). The primary outcome was the difference in the incidence rate of liver-related hospitalizations. Secondary outcomes included differences in the incidence of hepatocellular carcinoma, liver transplant, and all-cause mortality. We calculated the projected savings per-patient treated per-year on the basis of calculated hospitalization rate stratified by Child–Turquotte–Pugh (CTP) score. Results: Baseline characteristics were similar between the untreated ( n =182) and DAA-treated ( n =196) cohorts. Mean follow-up time in the untreated and treated cohort was 20.4 and 17.7 months, respectively. The incidence rates of liver-related hospitalizations were 29.1/100 and 10.4/100 person-years of follow-up ( P⩽ 0.0001) in the untreated and treated cohorts, respectively. This was accounted for by a decreased incidence of hospitalizations in patients with CTP-A (75.8%) and CTP-B (64.5%), but not CTP-C. Conclusion: Successful DAA treatment reduces hospitalization rate and resource utilization costs in patients with CTP-A and CTP-B, but not in those with CTP-C. Abstract : Supplemental Digital Content is available in the text.