The most cost-effective time to treat hepatitis C virus (HCV) for those eligible for a liver transplant depends on the severity of their liver disease at the time of the transplant.
Publishing their findings in Alimentary Pharmacology and Therapeutics, researchers used a mathematical model to simulate follow-up of a group of people with genotype 1 or 4 of hep C from the time they registered for a liver transplant until their death.
The researchers used the model to analyze the cost-effectiveness of treating with Harvoni (ledipasvir/sofosbuvir) plus ribavirin for 12 weeks according to three strategies: 1) treating before a liver transplant; 2) treating after a liver transplant but before recurrence of hep C in the new organ; 3) treating after hep C has recurred post-transplant.
According to a model that assumed the median end-stage liver disease (MELD) score was less than 25 at the time of the transplant, the researchers found that treating hep C before the transplant led to greater additional quality-adjusted life-years (QALYs) for less money compared with the other two treatment strategies.
A QALY is one year lived in optimal health. A year lived in less than optimal health counts as less than one QALY in proportion to the diminishment of health.
After conducting the analysis based on the cohort having a MELD score of 25 or above, decompensated cirrhosis and hepatocellular carcinoma (HCC, the most common form of liver cancer), respectively, the researchers found that for each scenario, treating hep C after the transplant but before hep C recurrence was the most cost-effective.
To read the study abstract, click here.